Meta-analysis on Radiofrequency Ablation in Combination with Transarterial Chemoembolization for the Treatment of HepatoceUular Carcinoma

• Published in: 华中科技大学学报：医学英德文版 Vol. 34; no. 5; pp. 692 - 700
• Main Author: 曹江慧 周军 张晓龙 丁勋 龙清云
• Format: Journal Article
• Language: English
• Published: 2014
• Subjects: Meta分析; 化疗; 原发性肝癌; 国家知识基础设施; 射频消融; 栓塞; 联合治疗; 肝动脉
• ISSN: 1672-0733; 1993-1352

To evaluate the efficacy and safety of transcatheter arterial chemoembolization （TACE） combined with radiofrequency ablation （RFA） and TACE alone for hepatocellular carcinoma （HCC）, Pubmed, Cochrane Library, Web of Science, China National Knowledge Infrastructure （CNKI） and Wanfang Datebases were searched for the randomized controlled trials （RCTs） and retrospective cohort studies from the establishment of the databases to January 2014. The bibliographies of the included studies were searched, too. After study selection, assessment, data collection and analysis were under- taken, we performed this meta-analysis by using the RevMan5.2 software. Seventeen studies involving 1116 patients met the inclusion criteria with 530 treated with RFA-plus-TACE and 586 with TACE alone. The results of meta-analysis showed that the combination of TACE and RFA was obviously as- sociated with higher 1-, 2-, and 3-year overall survival rates （OR1-year=3.98, 95% CI 2.87-5.51, P〈0.00001; OR2-year=3.03, 95% CI 2.10-4.38, P〈0.00001; OR3-year=7.02, 95% CI 4.14-11.92, P〈0.00001） than TACE alone. The tumor complete necrosis rate in patients treated with TACE and RFA was higher than that of TACE alone （OR=13.86, 95% CI 8.04-23.89, P〈0.00001）. And there was a significant difference in local recurrence rate between two different kinds of treatment （OR=0.24, 95%CI 0.14-0.44, P〈0.00001）. Additionally, combination of TACE and RFA was associated with higher complete tumor necrosis rates than TACE mono-therapy in the treatment of HCC. However, RFA plus TACE was found to be associated with a lower local recurrence rate than TACE monotherapy TACE-plus-RFA treatment was associated with a higher response rate （RR） than the TACE-alone treat- ment （OR=3.90, 95% CI=2.37-5.42, P〈0.00001）. TACE-plus-RFA treatment did not differ from the TACE-alone treatment in terms of stable disease （SD） rate （OR=0.38, 95% CI=0.11-1.26, P=-0.11）. Meta-analyses showed that the combination of RFA and TACE was associated with a significantly lower progressive disease （PD） rate （OR=0.15, 95% CI=0.05M3.43, P=-0.0005）. The rate of AFP reduc- ing or returning to normal in serum in RFA plus TACE group was obviously lower than TACE alone group （OR=4.62, 95% CI 2.56-8.34, P〈0.00001）. The effect of TACE plus RFA for HCC is better than TACE mono-therapy. The combined therapy can elevate the patients＇ overall survival rate, tumor ne- crosis rate and the rate of AFP reducing or returning to normal in serum and decrease local recurrence rate, PD rate compared with TACE alone.