| Background Intrahepatic cholangiocarcinoma(ICC)is a highly invasive malignant tumor,and its incidence has been increasing year by year since the 21st century.Hepatectomy has always been recognized as the most effective treatment for the disease,but because of the atypical early symptoms of ICC,most patients are diagnosed at the late stage,and only 33%of the patients have the chance of surgical resection.At the same time,it is easy to relapse after ICC resection,and the prognosis is not satisfactory.Scholars have been studying various adjuvant treatments to improve the prognosis of patients after ICC resection.Transcatheter arterial chemoembolization(TACE),as a commonly used adjuvant therapy for liver diseases,is mainly used in the early stage of unresectable primary liver cancer and metastatic liver cancer.Current studies have confirmed that TACE can effectively improve the prognosis of patients with ICC who do not have the opportunity to receive surgical treatment.However,it is not clear whether adjuvant TACE therapy can improve the prognosis of patients after ICC resection.At this stage,the relevant research in this field has not reached a consensus,and there is still a lack of systematic meta-analysis(meta-analysis)to systematically evaluate the efficacy of TACE after ICC.Objective In this study,we systematically searched the published literature about TACE treatment after ICC resection,and extracted the basic information and prognosis of patients with and without TACE treatment after ICC.Statistical methods were used to evaluate the differences in overall survival(OS)rate,recurrence rate and death hazard ratio(HR),so as to provide theoretical reference for the treatment of patients after ICC.Methods According to the retrieval strategy,the Chinese database(from October 1,2020)and the English database(from October 1,2020)were searched comprehensively and systematically,and the relevant literatures about the treatment of TACE after ICC resection were searched strictly according to the pre-established literature inclusion and exclusion criteria.The effective information related to this study was extracted from these literatures,and the prognostic differences between receiving TACE and not receiving TACE after ICC resection were compared.The outcome indicators were 1-year,3-year,5-year OS rate,recurrence rate,and HR,efficacy indicators of death treated with TACE compared with those without TACE treatment were expressed by odds ratio(OR)and 95%confidence interval(CI)or HR and 95%CI.The heterogeneity of each study is detected by statistics Q and I2.If I2>50%and P<0.05,it means that there is statistical heterogeneity.At this time,the random effect model is used to calculate the value of the combined effect,otherwise the fixed effect model will be used to calculate the size of the combined effect.The result analysis of the main outcome indicators was expressed in the form of forest map and table,and the difference was considered to be statistically significant when P<0.05.The sensitivity analysis of the main outcome indexes between the TACE treatment group and the non-TACE treatment group was used to evaluate the combined effect and the heterogeneity between the studies,and to obtain the effect of one or more studies on the combined effect and heterogeneity.In addition,Egger’s test was used to determine publication bias to explore whether the results of this meta-analysis were robust,and a"Trim and fill" method was introduced to examine the impact of potentially unpublished studies on current results.Results Through rigorous screening and careful reading of the relevant literature in this field,this analysis included a total of 10 retrospective studies,including 1849 patients after ICC,and the subjects were all from China.All the above outcome indicators included in the study were combined and analyzed.The results of heterogeneity test showed that 1-year OS rate(Chi2=3.52,I2=0.0%,P=0.742)and 5-year recurrence rate(Chi2=0.08,I2=0.0%,P=0.771)had no heterogeneity,3-year OS rate(Chi2=9.29,I2=35.4%,P=0.158),1-year recurrence rate(Chi2=5.35,I2=43.9%,P=0.148)and HR(Chi2=11.96,I2=41.5%,P=0.102)showed mild heterogeneity.The combined effect was calculated by fixed effect model.The heterogeneity of 5-year OS rate(Chi2=6.46,I2=53.5%,P=0.091)and 3-year recurrence rate(Chi2=9.16,I2=67.3%,P=0.027)was statistically significant,and the combined effect was analyzed and calculated by random effect model.Compared with not receiving TACE after radical resection of ICC,TACE treatment significantly increased the 1-year OS rate(OR=2.26,95%CI:1.67-3.05,P<0.001),3-year OS rate(OR=2.23,95%CI:1.68-2.96,P<0.001)and 5-year OS rate(OR=2.03,95%CI:1.07-3.87,P=0.031).However,TACE could not reduce the 1-year recurrence rate(OR=0.75,95%CI:0.56-1.01,P=0.057),3-year recurrence rate(OR=0.60,95%CI:0.33-1.11,P=0.104)and 5-year recurrence rate(OR=0.78,95%CI:0.51-1.18,P=0.230)after ICC resection.In addition,the risk of death after ICC in the TACE treatment group was significantly lower than that in the control group(HR=0.66,95%CI:0.56-0.78,P<0.001).The results of sensitivity analysis showed that the effect of each outcome index and its 95%CI did not change significantly after removing any study,which indicated that the results of this study were stable and reliable.Although there is publication bias in the 3-year OS rate,the "cut-and-complement" analysis shows that there is no significant change in the combined effect after adding some data,suggesting that this study is not affected by publication bias.Conclusion 1.The results of meta-analysis show that although TACE is difficult to delay the recurrence of ICC,it can significantly increase the 1-year,3-year and 5-year OS rate of patients,reduce the risk of death,and improve the prognosis,which is worthy of further promotion and application.2.The current studies on the clinical efficacy of adjuvant TACE therapy after ICC resection are mainly based on clinical retrospective studies,which may also need to be supported by large samples,high-quality randomized controlled trials(RCT). |
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