Meta Analysis Of TACE Combined With Sorafenib VS TACE Monotherapy In The Treatment Of Unresectable Hepatocellular Carcinoma In Its Middle And Advanced Stage

Objective:to systematically evaluate the safety and efficacy of TACE combined with Sorafenib VS TACE monotherapy in the treatment of unresectable hepatocellular carcinoma in its middle and advanced stage and to discuss the feasibility of its downstaging and conversion therapyMethod:Databases home and abroad were retrieved by computer.The Chinese databases include CNKI,Weipu,Wanfang and Sinomed,while the English databases include PubMed,Embase and the Cochrane library,in search of the researches comparing TACE combined with Sorafenib with TACE monotherapy in the treatment of unresectable hepatocellular carcinoma in its middle and advanced stage.Compile the researches,extract the data and use Revman 5.3 to analyse.Results:With 23 randomized control trials included,there are 2651 patients in total,1320 patients classified into the combination group and 1331 patients into the control group.The results show:six months survival rate(OR=3.29,95%CI:1.91 to 5.66,P<0.0001),one year survival rate(OR=3.03,95%CI:2.32 to 3.96,P<0.00001),two year survival rate(OR=2.40,95%CI:1.09 to 5.31,P<0.03),after sensitivity analysis(OR=3.22,95%CI:1.96 to 5.29,P<0.00001),complete response rate(OR=1.70,95%CI:1.21 to 2.38,P=0.002),partial response rate(OR=1.64,95%CI:1.36 to 1.99,P<0.00001),objective response rate(OR=1.87,95%CI:1.55 to 2.25,P<0.00001),disease control rate(OR=3.17,95%CI:2.11 to 4.79,P<0.00001),fever(OR=1.12,95%CI:0.79 to 1.60,P=0.53),high blood pressure(OR=2.42,95%CI:1.76 to 3.32,P<0.00001),hand-foot syndrome(OR=14.75,95%CI:10.66 to 20.41,P<0.00001),bone marrow suppression(OR=1.15,95%CI:0.83 to 1.60,P=0.41),abnormal liver function(OR=1.14,95%CI:0.85 to 1.53,P=0.37),time to progression(HR=0.85,95%CI:0.74 to 0.99,P=0.04),median overall survival rate(HR=0.94,95%CI:0.76 to 1.16,P=0.57)Conclusions:For the efficacy of TACE combined with Sorafenib in its treatment of unresectable hepatocellular carcinoma in its middle and advanced stage,in the six months,one year and two year survival rates,combination group is superior to control group,but in the median overall survival rate,combination group is comparable to control group.In all of the complete response,partial response,objective response and disease control rates based on mRECIST,combination group is superior to control group.For the safety,in the reverse effects like fever,bone marrow suppression and abnormal liver function,combination group is comparable to control group;in the reverse effects like high blood pressure and hand-foot syndrome,combination group has higher occurrence rate than control group.For the feasibility,to truly improve the long-term survival rate of combination group,surgical treatment selectively applied to patients who have achieved complete response or partial response is likely to improve their long-term survival rate.