Xie Hui, Yu Haipeng, Tian Shengtao, Yang Xueling, Wang Ximing, Yang Zhao, Wang Huaming, Guo Zhi
Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin 300070, China.
Department of Interventional Therapy, 302 Hospital of People's Liberation Army, Beijing 100039, China.
Oncotarget. 2017 Aug 10;8(59):100508-100523. doi: 10.18632/oncotarget.20119. eCollection 2017 Nov 21.
To assess the comparative efficacy and safety of combination treatment with transarterial chemoembolization (TACE) for patients with unresectable hepatocellular carcinoma (HCC) through a systematic review and network meta-analysis and to identify what is the best combination treatment with TACE.
A network meta-analysis was used to identify evidence from relevant randomized controlled trials. We searched databases for publications up to June 2017. The prespecified primary efficacy outcomes were treatment response and 6-month to 3-year overall survival (OS), while the secondary efficacy outcomes were 1- and 2-year disease-free survival (DFS); safety outcomes were advance effects of combination treatment. We conducted pairwise meta-analyses using a random-effects model and then performed random-effects network meta-analyses.
A total of 48 trials were eligible (50 analyses), involving 5627 patients and 19 treatment arms. In comparison with other types of combination therapy arms, network meta-analysis disclosed that TACE + three-dimensional conformal radiotherapy, TACE + percutaneous ethanol injection, TACE + percutaneous microwave coagulation therapy, TACE + percutaneous acetic acid injection, and TACE + sorafenib were the more effective methods in treatment response, 6-month to 3-year OS, and 1-2 year DFS; the adverse effects of TACE + sorafenib were serious. The study was registered with PROSPERO, number CRD42017071102.
When considering the efficacy, combination therapy with TACE seemed to offer clear advantages for patients with unresectable HCC. TACE + Three-dimensional conformal radiotherapy, TACE + Percutaneous ethanol injection, TACE + Percutaneous microwave coagulation therapy, and TACE + Percutaneous acetic acid injection are likely the best options to consider in the application of combination treatment.
通过系统评价和网状Meta分析评估经动脉化疗栓塞术（TACE）联合治疗不可切除肝细胞癌（HCC）患者的疗效和安全性，并确定TACE最佳联合治疗方案。
采用网状Meta分析从相关随机对照试验中获取证据。检索数据库至2017年6月的出版物。预先设定的主要疗效指标为治疗反应和6个月至3年总生存期（OS），次要疗效指标为1年和2年无病生存期（DFS）；安全性指标为联合治疗的不良反应。采用随机效应模型进行成对Meta分析，然后进行随机效应网状Meta分析。
共有48项试验符合要求（50项分析），涉及5627例患者和19个治疗组。网状Meta分析显示，与其他联合治疗组相比，TACE+三维适形放疗、TACE+经皮乙醇注射、TACE+经皮微波凝固治疗、TACE+经皮乙酸注射以及TACE+索拉非尼在治疗反应、6个月至3年OS和1至2年DFS方面疗效更佳；TACE+索拉非尼的不良反应严重。该研究已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42017071102。
考虑疗效时，TACE联合治疗对不可切除HCC患者似乎具有明显优势。TACE+三维适形放疗、TACE+经皮乙醇注射、TACE+经皮微波凝固治疗以及TACE+经皮乙酸注射可能是联合治疗应用中最佳的选择。
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