Department of Gastroenterology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
Liver Int. 2010 May;30(5):741-9. doi: 10.1111/j.1478-3231.2010.02221.x. Epub 2010 Mar 18.
Recent evidence suggests that transcatheter arterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) or a percutaneous ethanol injection (PEI) may have a synergistic effect in treating hepatocellular carcinoma (HCC). The aim of the current meta-analysis was to identify the survival benefits of TACE combined with percutaneous ablation (PA) therapy (RFA or PEI) for unresectable HCC compared with those of TACE or PA alone.
Randomized-controlled trials (RCTs) published as full papers or abstracts were searched to assess the survival benefit or tumour recurrence for patients with unresectable HCC on electronic databases. The primary outcome was survival. The secondary outcomes were response to therapy and tumour recurrence.
Ten RCTs met the criteria to perform a meta-analysis including 595 participants. TACE combined with PA therapy, respectively improved, 1-, 2-, and 3-year overall survival compared with that of monotherapy [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.14-4.57; P=0.020], (OR=4.53, 95% CI 2.62-7.82, P<0.00001) and (OR=3.50, 95% CI 1.75-7.02, P=0.0004). Sensitivity analysis demonstrated a significant benefit in 1-, 2- and 3-year overall survival of TACE plus PEI compared with that of TACE alone for patients with large HCC lesions, but not in TACE plus RFA vs RFA for patients with small HCCs. The pooled result of five RCTs showed that combination therapy decreased tumour recurrence compared with that of monotherapy (OR=0.45, 95% CI 0.26-0.78, P=0.004).
TACE combined with PA therapy especially PEI improved the overall survival status for large HCCs.
最近的证据表明，经导管动脉化疗栓塞术（TACE）联合射频消融术（RFA）或经皮乙醇注射术（PEI）可能对治疗肝细胞癌（HCC）具有协同作用。本荟萃分析的目的是确定与单独 TACE 或 PA 相比，TACE 联合经皮消融（RFA 或 PEI）治疗不可切除 HCC 的生存获益。
在电子数据库中搜索发表全文或摘要的随机对照试验（RCT），以评估不可切除 HCC 患者的生存获益或肿瘤复发情况。主要结局是生存。次要结局是治疗反应和肿瘤复发。
符合纳入标准并进行荟萃分析的 RCT 有 10 项，共纳入 595 名患者。与单独 TACE 相比，TACE 联合 PA 治疗分别提高了 1、2 和 3 年的总生存率[比值比（OR）2.28，95%置信区间（CI）1.14-4.57；P=0.020]，（OR=4.53，95% CI 2.62-7.82，P<0.00001）和（OR=3.50，95% CI 1.75-7.02，P=0.0004）。敏感性分析显示，对于大 HCC 病变患者，TACE 联合 PEI 治疗在 1、2 和 3 年总生存率方面有显著获益，但对于小 HCC 患者，TACE 联合 RFA 与 RFA 相比没有获益。五项 RCT 的汇总结果表明，联合治疗与单独治疗相比降低了肿瘤复发率（OR=0.45，95% CI 0.26-0.78，P=0.004）。
TACE 联合 PA 治疗，特别是联合 PEI 可改善大 HCC 的总体生存状况。
