Adjuvant Transarterial Chemoembolization After Curative Resection For Patients Of Hepatocellular Carcinoma:a Meta-analysis

Objectives:The meta-analysis was performed to evaluate the efficacy and safety of adjuvant transarterial chemoembolization(TACE)after hepatectomy in improving survival and tumor-free survival in patients with hepatocellular carcinoma(HCC)complicated by microvascular invasion(MVI).Methods:Retrieved multiple electronic databases by using related search terms on a computer,including PubMed,Medline(EBSCO),Web of Science,EMBASE database,a comprehensive search of the literature published before December 31,2018 on the efficacy and safety of adjuvant transarterial chemoembolization(TACE)after hepatectomy in improving survival and tumor-free survival in patients with hepatocellular carcinoma(HCC),and browsed the related literature references,and then to manually search for possible related references,limited to the English language.Strict inclusion and exclusion criteria were established,and then the literature was screened and data extracted by two researchers.The selected literature was then evaluated according to the bias risk assessment tool for RCT in the Cochrane application manual and the NOS quality assessment form for Retrospective.Review Manager 5.3 software was used for meta-analysis of the included literature.Risk ratio HR and 95%confidence interval were used as effect indicators to calculate the risk ratio of survival rate and tumor-free survival rate of patients with hepatocellular carcinoma treated with TACE after hepatectomy.The heterogeneity test was performed,and the meta-analysis model was selected according to the P value and I~2 statistics in the Q value statistic test.If there is no obvious heterogeneity between the studies,the fixed effect model is adopted.Otherwise,the random effect model is adopted.Where heterogeneity exists,subgroup analysis of the source of heterogeneity is performed.The publication bias was evaluated by observing the symmetry of funnel plots.Sensitivity analysis was used to assess the stability of the results.Results:A total of 1520 articles were retrieved from four electronic databases on the computer through the developed retrieval strategy,including 390 articles from PubMed,388 articles from Medline(EBSCO),256 articles from Web of Science,and 486 articles from EMBASE.By reading the title,abstract and full text,1502 articles were excluded,and the remaining 17 articles met the inclusion criteria,including 5 randomized controlled studies and 12 retrospective case-control studies.A total of 5083 cases were included in the meta-analysis.The results of meta-analysis showed that HCC patients treated with TACE after hepatectomy had higher survival(HR:0.56,95%CI:0.51-0.62)and tumor-free survival(HR:0.73,95%CI:0.68-0.79)than those without TACE.The corresponding heterogeneity test were I~2=0%and P=0.89?I~2=0%and P=0.59respectively.Funnel plot test showed no publication bias.The results of subgroup analysis showed that postoperative adjuvant TACE treatment could effectively improve survival rate(HR:0.56,95%CI:0.47-0.68)and tumor-free survival rate(HR:0.65,95%CI:0.56-0.74)in patients with HCC complicated by Microvascular Ivasion(MVI)Postoperative adjuvant TACE therapy was not effective in improving survival(HR 0.86,95%CI 0.43-1.75)and tumor-free survival(HR 0.92,95%CI 0.65-1.29)in HCC patients without Microvascular Ivasion(MVI).Sensitivity analysis suggested that the results of this meta-analysis were stable.Conclusion:Compared with the operation alone,the adjuvant TACE treatment after hepatectomy can effectively reduce the recurrence rate and improve the survival rate of HCC patients with MVI.And there was no difference in those without MVI.