Jiang Chuang, Cheng Gong, Liao Mingheng, Huang Jiwei
Department of Liver Surgery, Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Gastroenterology, Cadre Ward, Gansu Provincial Hospital, lanzhou, Gansu, China.
World J Surg Oncol. 2021 Mar 19;19(1):81. doi: 10.1186/s12957-021-02188-4.
There is still some debate as to whether transcatheter arterial chemoembolization (TACE) plus radiofrequency ablation (RFA) is better than TACE or RFA alone. This meta-analysis aimed to compare the efficacy and safety of TACE plus RFA for hepatocellular carcinoma (HCC) with RFA or TACE alone.
We searched PubMed, MEDLINE, Embase, Cochrane Library, and CNKI (China National Knowledge Infrastructure) for all relevant randomized controlled trials and retrospective studies reporting overall survival (OS), recurrence-free survival (RFS), and complications of TACE plus RFA for HCC, compared with RFA or TACE alone.
Twenty-one studies involving 3413 patients were included. TACE combined with RFA was associated with better OS (hazard ratio [HR]=0.62, 95% confidence intervals [CI] = 0.55-0.71, P < 0.001) and RFS (HR = 0.52, 95% CI = 0.39-0.69, P < 0.001) than TACE alone; compared with RFA alone, TACE plus RFA resulted in longer OS (HR = 0.63, 95% CI = 0.53-0.75, P < 0.001) and RFS (HR = 0.60, 95% CI = 0.51-0.71, P < 0.001). Subgroup analyses by tumor size also showed that combined treatment resulted in better OS and RFS compared with RFA alone in patients with HCC larger than 3 cm. Combined treatment resulted in similar rate of major complications compared with TACE or RFA alone (OR = 1.78, 95% CI = 0.99-3.20, P = 0.05; OR = 1.00, 95% CI = 0.42-2.38, P = 1.00, respectively).
TACE combined with RFA was more effective for HCC than TACE alone. For patients with a tumor larger than 3 cm, the combined treatment also achieved a better effect than RFA alone.
关于经动脉化疗栓塞术（TACE）联合射频消融术（RFA）是否优于单纯TACE或RFA仍存在一些争议。本荟萃分析旨在比较TACE联合RFA与单纯RFA或TACE治疗肝细胞癌（HCC）的疗效和安全性。
我们检索了PubMed、MEDLINE、Embase、Cochrane图书馆和中国知网（CNKI），以查找所有相关的随机对照试验和回顾性研究，这些研究报告了TACE联合RFA治疗HCC的总生存期（OS）、无复发生存期（RFS）和并发症，并与单纯RFA或TACE进行比较。
纳入了21项涉及3413例患者的研究。与单纯TACE相比，TACE联合RFA的OS更好（风险比[HR]=0.62，95%置信区间[CI]=0.55-0.71，P<0.001），RFS也更好（HR=0.52，95%CI=0.39-0.69，P<0.001）；与单纯RFA相比，TACE联合RFA的OS更长（HR=0.63，95%CI=0.53-0.75，P<0.001），RFS也更长（HR=0.60，95%CI=0.51-0.71，P<0.001）。按肿瘤大小进行的亚组分析还显示，对于肿瘤大于3 cm的HCC患者，联合治疗与单纯RFA相比，OS和RFS更好。联合治疗与单纯TACE或RFA相比，主要并发症发生率相似（OR分别为1.78，95%CI=0.99-3.20，P=0.05；OR为1.00，95%CI=0.42-2.38，P=1.00）。
TACE联合RFA治疗HCC比单纯TACE更有效。对于肿瘤大于3 cm的患者，联合治疗也比单纯RFA效果更好。
