| Background:In China,the prevalence of primary hepatic carcinoma(PHC) is one of the highest digestive system malignant tumors. The PHC was the third leading cause of dead in all malignant tumor, followed by lung carcinoma and stomach carcinoma. PHC displayed the higher malignant degree, rapid and uncontrolled tumor development, which usually could not to be found at early stages and attained proper surgical treatment. Recently, transcatheter arterial chemoembolization(TACE) has been applied for non-surgical resection treatment of advanced PHC. Moreover, Radiofrequency ablation(RFA) was a novel micro invasive treatment that was emerged in recent years, which was used for early stage PHC and showed good results. Currently, clinicians has combined TACE and RFA to treat non-surgical treatment of advanced PHC, but whether such combination treatment could significantly improved the treatment effect for PHC and prolonged the survival period of patients still did not reached a consensus. This study used Meta analysis to figure out if this combination had the obvious treatment result.Objective:Through the Meta analysis of TACE combined RFA for non-surgical resection treatment of advanced PHC patients, to explore whether the treatment effect could be improved by the combined treatment and wehether the survival time of advanced PHC patients could be prolonged.Method:Computer searched the Pubmed, the Chinese biomedical datebase(CBM) and the China hownet journal data base(CNKl) to collect the domestic and external articles about the treatment of TACE combined RFA for non-surgical resection treatment of advanced PHC, time period from 2000 to 2014, including randomized controlled trials(RCT) and non-randomized concurrent control trials(NRCT), Language was restricted to Chinese and English. The Revman5.2 statistical analysis software was used for Meta analysis of above collected data. The variables consisted of Compared combination therapy and simple TACE treatment, the influence of the treatment effect, survival rate, tumor response rate and tumor recurrence rate.Results:According to the selection criteria of this study, a total of 12 literatures with 941 patients were included. The Barcelona clinic staging of PHC were stage B and C for all patients. In the experimental group, all patients were treated with TACE combined with RFA, on the other hand, the patients of control group were treated with TACE only. There were 5 RCTs with 419 patients and 7 NRCTs with 522 patients included in this study.According to Meta analysis, the RR for one year survival rate of patients was 1.30, 95%CI[1.21, 1.39], P<0.00001, the RR for two years survival rate of patients was 1.82, 95%CI[1.48, 2.24], P<0.00001, the RR for three years survival rate of patients was 2.55, 95%CI[1.51, 4.30], P=0.0005. At the follow up period of one year, two years and three years, the survival rate of the experimental group was higher than that of control group. The RR for tumor response rate of patients was 1.62, 95%CI[1.40, 1.88], P<0.00001. The tumor response rate of experimental group was better than that of the control group. The RR for tumor recurrence rate of patients was 0.33, 95%CI[0.18, 0.60], P=0.0002. The tumor recurrence rate of experimental group was lower than that of control group. Additionally, Only four studies reported the complications of the treatment. Due to the standard of adverse reaction evaluation was not consistent so far, so Meta analysis was not employed for clinical complications. According to these limited studiest, there had no obvious difference between the experimental group and control group in terms of adverse reation.Conclusions:The Meta-analysis results of this study showed TACE combined with RFA therapy was better than TACE for non-surgical treatment of PHC, the long-term cure rate and survival rate was significantly increased in PHC patients. |
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