Marelli Laura, Stigliano Rosa, Triantos Christos, Senzolo Marco, Cholongitas Evangelos, Davies Neil, Yu Dominic, Meyer Tim, Patch David W, Burroughs A K
Liver Transplantation and Hepatobiliary Medicine Unit, Royal Free Hospital, Pond Street, NW3 2QG London, UK.
Cancer Treat Rev. 2006 Dec;32(8):594-606. doi: 10.1016/j.ctrv.2006.08.002. Epub 2006 Oct 11.
Although transarterial chemoembolization (TACE) improves survival in patients with hepatocellular carcinoma (HCC), it is not known if TACE combined with other treatments is beneficial.
To evaluate the evidence for improved outcomes in HCC with a multimodal treatment approach involving TACE.
PubMed search for all cohort and randomized trials (n=84) evaluating TACE combined with other therapies; meta-analysis performed where appropriate.
A meta-analysis involving 4 RCTs showed a significant decrease in mortality favouring combination treatment (TACE plus percutaneous ablation) compared to monotherapy in patients with either small (<3cm) or large HCC nodules (>3cm) (OR, 0.534; 95% CI, 0.288-0.990; p=0.046). TACE combined with local radiotherapy improved survival in patients with tumour thrombosis of the portal vein in 7 non-randomized studies. Two RCTs and 13 non-randomized studies showed that TACE prior to hepatic resection does not improve survival nor tumour recurrence. Conversely, 2 RCTs and 5 comparative studies showed that transarterial injection of chemotherapeutic drugs mixed with lipiodol (TOCE) following hepatectomy confers survival benefit and less tumour recurrence. TACE before liver transplantation is safe and reduces drop-out rate from the waiting list, but there is no current evidence of improvement in subsequent survival or recurrence rate.
A combined approach involving TACE and percutaneous ablation improves survival. Adjuvant TOCE improves outcome after hepatectomy. TACE is useful to control tumours burden while on the waiting list for OLT. Multimodal treatment seems to be the best way to optimize TACE outcomes in HCC.
尽管经动脉化疗栓塞术（TACE）可提高肝细胞癌（HCC）患者的生存率，但TACE联合其他治疗是否有益尚不清楚。
评估采用涉及TACE的多模式治疗方法改善HCC预后的证据。
在PubMed上检索所有评估TACE联合其他疗法的队列研究和随机试验（n = 84）；在适当情况下进行荟萃分析。
一项涉及4项随机对照试验的荟萃分析显示，与单药治疗相比，联合治疗（TACE加经皮消融）使小肝癌（<3cm）或大肝癌结节（>3cm）患者的死亡率显著降低（OR，0.534；95%CI，0.288 - 0.990；p = 0.046）。7项非随机研究表明，TACE联合局部放疗可改善门静脉肿瘤血栓形成患者的生存率。两项随机对照试验和13项非随机研究表明，肝切除术前进行TACE并不能提高生存率或降低肿瘤复发率。相反，两项随机对照试验和5项比较研究表明，肝切除术后经动脉注射与碘油混合的化疗药物（TOCE）可带来生存益处并减少肿瘤复发。肝移植前进行TACE是安全的，可降低等待名单上的退出率，但目前尚无证据表明其能改善后续生存率或复发率。
TACE与经皮消融相结合的联合治疗方法可提高生存率。辅助性TOCE可改善肝切除术后的预后。TACE有助于在等待肝移植期间控制肿瘤负荷。多模式治疗似乎是优化HCC中TACE疗效的最佳方法。
