Meta-analysis of transcatheter arterial chemoembolization plus radiofrequency ablation versus transcatheter arterial chemoembolization alone for hepatocellular carcinoma

Abstract

This meta-analysis was conducted to compare transcatheter arterial chemoembolization (TACE) plus radiofrequency ablation (RFA) with TACE alone for hepatocellular carcinoma. We searched MEDLINE, EMBASE and CENTRAL for all relative randomized controlled trials (RCTs) and retrospective studies until October 31 2016. Tumor response, recurrence-free survival, overall survival and postoperative complications were the major evaluation indices. Review Manager (version 5.3) was used to analyze the data. Dichotomous data was calculated by odds ratio (OR) with 95% confidence intervals (CI). There were 1 RCT and 10 retrospective studies with 928 patients in this meta-analysis: 412 patients with TACE plus RFA and 516 patients with TACE alone. Compared with TACE alone group, TACE plus RFA group attained higher tumor response rates (OR = 6.08, 95% CI = 4.00 to 9.26, P < 0.00001), achieved longer recurrence-free survival rates (ORRFS = 3.78, 95% CI: 2.38 to 6.02, P < 0.00001) and overall survival rates (OR1-year = 3.92, 95% CI = 2.41–6.39, P < 0.00001; OR3-year = 2.56; 95% CI = 1.81–3.60; P < 0.00001; OR5-year = 2.78; 95% CI = 1.77–4.38; P < 0.0001). Serious postoperative complications were not observed, although complications were higher in TACE plus RFA group than that in TACE alone group (OR = 2.74, 95% CI = 1.07 to 7.07, P = 0.04). In conclusion, the use of TACE plus RFA for intermediate stage hepatocellular carcinoma can attain higher tumor response rates and improve survival rates than TACE alone.

Individual or combined transcatheter arterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma: a time-to-event meta-analysis

“…They analyzed six studies with 534 patients and showed similar OS and RFS. Yang et al [ 21 ] investigated the outcome of TACE+RFA compared to TACE alone in HCC patients. They showed a survival benefit for combined therapy compared to TACE alone (OR 1-year = 3.92, 95% CI = 2.41–6.39, p <0.00001; OR 3-year = 2.56; 95% CI = 1.81–3.60; p <0.00001; OR 5-year = 2.78, 95% CI= 1.77–4.38; p < 0.0001).…”

Combined Treatments in Liver Ablations

“…31 Despite the limited number of randomized studies, several meta-analyses have been published in the attempt to assess the value of combined TACE-RFA compared with monotherapies (►Table 2). [32][33][34][35][36][37][38][39] The majority of these meta-analyses confirmed that the combination therapy is able to significantly improve local tumor control and OS compared with either RFA or TACE, in selected populations. In particular, while there seems not to be any advantage in small and large-size tumors, the combined approach should be indicated for lesions 3 to 5 cm in size.…”

Early experience of combination therapy of transarterial chemoembolization and radiofrequency ablation for hepatocellular carcinoma measuring 3–7 cm

“…In comparison, the LTP rates after TACE-RFA have generally been lower than those of RFA alone, with previously published rates of 2.9%–14.5% over median follow-up periods of 37.0–50.0 months. [678910] Kim et al . [7] observed LTP in 40% of treated lesions in the combined treatment group and 70% in the RFA-alone group.…”

“…in their meta-analysis concluded that use of TACE plus RFA for intermediate stage hepatocellular carcinoma can attain higher tumor response rates and improve survival rates than TACE alone. [8] According to Xie et al ., the 1-, 2-, 3-, 4- and 5-year overall survival rates after RFA and TACE treatment were 97.5%, 89.4%, 84.2%, 80.4% and 78.7%, respectively. [14]…”