Efficacy Of Combined Transhepatic Arterial Chemoembolization And Other Topical Therapies For The Treatment Of Unresectable Primary Liver Cancer: A Systematic And Meta-analysis

Objective To evaluate the efficacy of combined transhepatic arterial chemoembolization(TACE)and other topical treatments compared with TACE alone for the treatment of unresectable primary liver cancer(PLC)by a system review and meta-analysis.Methods Clinical studies from the building of each database to December 2018 were searched from the Wangfang,CNKI,VIP,Pubmed and Cochrane Library databases,and randomized controlled trials associated with the combination-treatment of other topical treatments and TACE for unresectable PLC were included.We screened literature according to pre-established inclusion and exclusion criteria,and evaluated the quality of the included studies.Meta-analyses were conducted by Rev Man5.3 statistical software.Results 44 eligible trials included a total of 4285 cases(1912 cases from TACE combined with other topical treatment group and 2373 cases from TACE alone treatment group)were assessed in this meta-analysis.Results from meta-analysis articles no publication bias and sensitivity analysis were statistically stable and reliable,as follows: 1.Overall effect of TACE combined with other topical treatments for the unresectable Primary Liver Cancer 1.1 The rate of changes in tumors Meta-analysis showed that results statistical tests did not indicate heterogeneity.After treatment,TACE combined with other topical treatments has effected in recent changes in tumors more than that TACE alone therapy.The difference between the two groups have statistical significance with OR(95%CI)2.82,95%CI [2.40,3.31],P <0.00001.1.2 The survival rate of patients After treatment,TACE combined with other topical treatments has improved 1,2 and 3-year survival rate of patients more than that TACE alone therapy.The difference between the two groups have statistical significance with OR(95%)=2.77[2.39,3.22],2.91 [2.37,3.56],3.79[3.05,4.71],p<0.00001.2.The effect of TACE combined with other topical treatments A great deal of literature has been reported that TACE combined with other topical therapies for the Treatment of unresectable Primary Liver Cancer,and our study mainly included the following 6 main kinds: TACE+3-DCRT,TACE+PEI,TACE+RFA,TACE+131I-metuxima,TACE+Iodine125,TACE+MWA.The primary outcome of the study is the rate of changes in tumors,and the secondary outcome is 1,2 and 3-year survival rate.Meta-analysis results as follows: 2.1 The effect of recent changes in tumors The six kinds of therapeutic regimen combined with TACE were clearly more effective than TACE alone therapy for the treatment of unresectable PLC.There were a statistically significant difference between the two groups with p<0.05.2.2 The survival rate of patients The six kinds of therapeutic regimen combined with TACE have improved 1-year survival rate more than that TACE alone therapy for the treatment of unresectable PLC.There are five kinds of therapeutic regimen: TACE+3-DCRT,TACE+PEI,TACE+RFA,TACE+Iodine125,TACE+MWA,however,there were not any reports on TACE+Iodine125.The five and four kinds of therapeutic regimen combined with TACE has prolonged 2 and 3-year survival rate respectively.There were a statistically significant difference between the two groups with OR>1,P<0.05.Conclusions 1.TACE combined with other topical therapies was more effective than TACE alone therapy for the treatment of unresectable primary liver cancer.2.Effect of TACE combined with other topical therapies: TACE combined with other topical therapies has 6 main kinds.Meta-analysis showed that six kinds of therapeutic regimen combined with TACE were clearly short-term effect more effective than that TACE alone therapy for the treatment of unresectable primary liver cancer,which are able to support extensive clinical application.