The Efficacy Of Combination Therapy Of TACE,PEI,or RFA For Hepatocellular Carcinoma:Meta Analysis Of Direct And Indirect Evidence

Background:Which combination therapy of transarterial chemoembolization, radiofrequency ablation therapy, percutaneous ethanol injection will be best for hepatocellular carcinoma were not found out.Objective:To identify the efficiency of combination therapy for patients with hepatocellular carcinoma (HCC) in comparison with a single treatment.To compare the efficiency of combination therapy for patients with hepatocellular carcinoma (HCC).Method:A literature search was carried out for all possible randomized-controlled trials,include randomized controlled trials about transarterial chemoembolization plus radiofrequency ablation therapy, transarterial chemoembolization plus percutaneous ethanol injection, percutaneous ethanol injection plus radiofrequency ablation therapy for HCC.The outcomes were overall survival rates.We estimated summary odds ratio(OR) with its95%confidence interval (95%CI) to assess the effects. Results:Thirteeen randomized controlled trials were identified as eligible for inclusion in this analysis.Our data analysis indicated that combination therapy was associated a higher overall survival rate (OR1-year=2.02,95%CI:1.44-2.81, P<0.0001;OR2-year=3.66,95%CI:2.04-6.56, P<0.0001; OR3-year=2.33,95%CI:1.82-2.99, P<0.00001; OR4-year=1.60,95%CI:1.06-2.41,P=0.02; OR5-year=2.21,95%CI:1.59-3.07,P<0.00001).The adjusted indirect meta analysis did not find any differences among TACE+RFA comparison RFA+PEI(OR1-year=0.52,95%CI:0.13-2.04, OR3-year=0.68,95%CI:0.24-1.89), TACE+RFA comparison RFA+PEI(OR1-year=0.94,95%CI:0.26-3.38; OR2-year=1.53,95%CI:0.20-11.53; OR3-year=0.90,95%CI:0.40-2.04; OR4-year=0.84,95%CI:0.30-2.35; OR5-year=1.23,95%CI:0.38-3.93), RFA+PEI comparison TACE+PEI (OR1-year=1.10,95%CI:0.03-48.52).Conclusion:The combination therapy of TACE,PEI, RFA has advantages in improving overall survival rate for patients with HCC than a single treatment. We did not find any differences among TACE+RFA comparison RFA+PEI, TACE+RFA comparison RFA+PEI, RFA+PEI comparison TACE+PEI. Background:Hepatocellular carcinoma is a serious threat to human life and health,its incidence and mortality were high in the world and China.Objective:To review the current non-drug treatment for hepatocellular carcinoma.Methods:A systematic review was conducted by searching Pubmed, and including the meta analysis of current non-drug therapy for primary hepatocellular carcinoma.Results:52meta-analyzes were included. Studies showed that surgery (surgical resection and liver transplantation) was the most effective method for primary hepatocellular carcinoma. Minimally invasive open and laparoscopic liver resection have the same efficacy as open liver resection and anatomical liver resection has better survival advantage.Liver transplantation is another kind of surgery. There were not any significances between different ways and timing. Liver resection and liver transplantation have similar5-year survival rate, but liver resection has better long-term survival benefits.Surgical treatment is the most effective treatment,and its survival advantage was significantly greater than transcatheter arterial chemoembolization.There were not any significant differences between any two single topical treatments with some complications.Therefore the combination of different single topical treatments should be the first choice for patients with hepatocellular carcinoma. Studies showed that the combination therapy has significantly higher survival advantages than single topical treatment.The most commonly used combination therapy was based on transcatheter arterial chemoembolization.Conclusions:Surgical treatment is the most effective treatment for patients with hepatocellular carcinoma, and single topical treatment should be combined.