Transcatheter Arterial Chemoembolization Combined Radiofrequency Ablation For Primary Hepatic Carcinoma: Meta-analysis

Background:Primary hepatic carcinoma(PHC) is one of the most common malignant tumor,the mortality rate ranks third of all diseases. Advanced PHC was often found because of its occult onset.Currently transcatheter arterial chemoembolization(TACE) occupies an important position in the treatment of advanced PHC,and good clinical results have been achieved.Radiofrequency ablation(RFA) also has positive efficacy to some PHC.In recent years,a commbined therapy of TACE and RFA has been applied to advanced PHC.It is worth discovering whether such combination therapy could significantly improve the treatment efficacy of primary hepatic carcinoma and prolong survival time.objective:To investigate whether or not the method of TACE combined RFA could improve the treatment efficacy in patients with advanced PHC and prolong their survival time,and to provide scientific basis for clinician whether this treatment method is worth promoting.Search strategy:We searehed the Pubmed,the Chinese BioMedical Literature(CBM) and the China National Knowledge Infrastructure(CNKI) to collect all the domestic and foreign articles about the treatment of TACE and RFA for PHC.Literature references were checked at the same time.Languages was restricted to Chinese and English.We collected all of the articles about randomized controlled trials(RCT) or non-randomized current controlled trials(NRCT) in the treatment of advanced PHC between TACE combined RFA and TACE alone,and between TACE combined RFA and RFA alone. Relevant clinical outcomes were combined for meta-analysis if available.Results:A total of 13 literatures and 835 Patients were included. Including 3 RCTs and 10 NRCTs.Data of one year survival rate from nine studies comparing TACE combined RFA to TACE alone was combined and the RR is 1.49,95%CI[1.29,1.71],P<0.00001.RR for two year survival rate of that is 1.97,95%CI[1.41,2.76],P<0.00001.Only one study reported data of three year survival rate of that,the three year survival rate of TACE combined RFA and TACE alone is 67.9%(19/28) and 14.3%(4/28),P<0.05.Data of one year survival rate from four studies comparing TACE combined RFA to RFA alone was combined and the RR is 1.26,95%CI[1.03,1.54], P= 0.03.RR for two year survival rate of that is 1.24,95%CI[1.03,1.48],P=0.02.Only one study reported data of three year survival rate of that,the three year survival rate of TACE combined RFA and RFA alone is 84.8% and 84.5% (P=0.515,log-rank test).Four studies reported the complications of the treatment. However, none of the complication data is appropriate for combination.So meta-analysis was not employed for clinical complications.Authors'Conclusions:Our meta-analysis of current evidence illustrates a favour in survival rate when TACE combined RFA compared to TACE alone,and also to RFA alone.The combination therapy could improve the treatment efficacy,prolong the survival time.However,due to the current lack of RCTs about TACE combined RFA for advanced PHC in international major hospitals, the conclusion that obtained in the basis of a small number of samples looks forward to being verified by large sample RCT,more RCTs are required in the future.