The Effects On The Prognosis Of Interventional Therapy Based On Evidence-based Medicine In Advanced Hepatocellular Carcinoma

Objective:To explore the effects on the prognosis of interventional therapy based on evidence-based medicine in advanced Hepatocellular carcinoma. Methods : After thoroughly evaluate the status of interventional therapy, clinical questions were raised . Searching by use of evidence based medicine methods in Cochrane library, EBSCO, Medline (Pubmed from Sep. 1990 to Sep. 2007), ACP journal Club (from Sep.1991 to Sep.2007) and Sumsearch.The searching subject is hepatocellular carcinoma, interventional therapy, systermatic review, meta-analysis etc. According to analyzing the searching results, rational evidence based interventional therapy regimes were made. The survival benefit was studied by comparing with the empirical counterpart at the same period and with the same inclusion criteria. Data analyses and Kaplan-Meier survival analyses were conducted using SPSS version 16.0 software. Log-rank test was used with signifcant difference analysis when indicated by P < 0.05. and Chi square test was used for the rate compare of count data. Results:Nine clinical question related randomized controlled clinical trials and three systermatic reviews were found and evaluated, from these evidence some conclusions were got:the patients who are belong to the BCLC B stage are more suite for interventional therapy,the transarterial chemoembolization(TACE) couldn't get more benefits than transarterial embolization(TAE),the superior selective embolization is better than non-superior selective embolization,all of the embolic agent ,the polyvinyl alcohol particles is the bset,and the next times intervention therapy date should be decided based on the new examination but shouldn't do it on time .Based on these evidences the evidence-based interventional therapy plan was made and included 230 cases of hepatocellular carcinoma between Sep. 2007~March 2008, devided them into to groups.There are 116 cases acepted the evidence-based interventional therapy and 114 cases were given the empirical interventional therapy.The side effects in the empirical interventional therapy group were more serious than evidence-based ?interventional therapy group. 2 years follow up results confirmed that the evidence based regimes were more appropriate for advanced hepatocellular carcinoma.The 1 year and 2 years overall survival rate have the difference significant (P<0.05),in evidence-based interventional therapy group were 84.5%,52.6%,respectively;But the empirical group were 71.1%,28.1% respectively. Conclusions: Choosing the interventional therapy regimes according to evidence-based medicine which can increase the clinical effect of and improve the prognosis of survival for advanced HCC.