Department of Radiology, Shengjing Hospital of China Medical University, Heping District, Shenyang, China.
Eur J Gastroenterol Hepatol. 2013 Feb;25(2):187-94. doi: 10.1097/MEG.0b013e32835a0a07.
There is a continuing debate on whether transcatheter arterial chemoembolization (TACE) plus radiofrequency ablation (RFA) is more effective than RFA alone in the treatment of patients with hepatocellular carcinoma (HCC). We carried out this meta-analysis of randomized-controlled trials to provide greater clarity on whether RFA plus TACE was more effective than RFA alone for HCC.
A literature search was carried out for all possible randomized-controlled trials. The outcomes were overall survival rates and major complications. Data were abstracted using standardized forms, and an overall rating of the quality of evidence was assigned using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria. We estimated summary odds ratio (OR) with its 95% confidence interval (95% CI) to assess the effects.
Seven randomized-controlled trials were included. Meta-analysis showed that RFA plus TACE significantly improved the survival rates of patients with HCC at 1 and 3 years (for the one-survival rate, fixed-effects OR=2.71, 95% CI 1.65-4.43, P<0.0001; for the three-survival rate, fixed-effects OR=2.27, 95% CI 1.57-3.27, P<0.0001) compared with RFA alone. There was no difference in terms of major complications (fixed-effects OR=1.26, 95% CI 0.33-4.77, P=0.73). Subgroup analyses by tumor size showed that RFA plus TACE significantly improved the survival rates at 1, 3, and 5 years compared with RFA alone in patients with HCC larger than 3 cm; however, there was no advantage of TACE plus RFA over RFA alone for patients with HCC smaller than 3 cm. The quality of evidence was high for the 1-year survival rate, the 3-year survival rate, and major complications. No evidence of publication bias was observed.
High-quality evidence suggests that TACE plus RFA improve the survival rates compared with RFA alone for patients with HCC larger than 3 cm.
经导管动脉化疗栓塞（TACE）联合射频消融（RFA）治疗肝细胞癌（HCC）是否优于单独 RFA 一直存在争议。我们进行了这项荟萃分析，以提供更明确的证据，证明 TACE 联合 RFA 是否比单独 RFA 更有效治疗 HCC。
对所有可能的随机对照试验进行文献检索。结局指标为总生存率和主要并发症。使用标准化表格提取数据，并使用 GRADE（推荐评估、制定与评价）标准对证据质量进行总体评价。我们使用汇总优势比（OR）及其 95%置信区间（95%CI）来评估效应。
纳入了 7 项随机对照试验。荟萃分析显示，与单独 RFA 相比，TACE 联合 RFA 显著提高了 HCC 患者的 1 年和 3 年生存率（对于单一生存率，固定效应 OR=2.71，95%CI 1.65-4.43，P<0.0001；对于三生存率，固定效应 OR=2.27，95%CI 1.57-3.27，P<0.0001）。两组之间主要并发症无差异（固定效应 OR=1.26，95%CI 0.33-4.77，P=0.73）。按肿瘤大小进行的亚组分析显示，对于肿瘤直径大于 3 cm 的 HCC 患者，TACE 联合 RFA 显著提高了 1 年、3 年和 5 年的生存率，而对于肿瘤直径小于 3 cm 的 HCC 患者，TACE 联合 RFA 并不优于单独 RFA。1 年生存率、3 年生存率和主要并发症的证据质量为高等级。未发现发表偏倚的证据。
高质量证据表明，对于肿瘤直径大于 3 cm 的 HCC 患者，TACE 联合 RFA 比单独 RFA 更能提高生存率。
