Comparison Of Transcatheter Arterial Chemoembolization Combined With Radiofrequency Ablation Or Microwave Ablation For The Efficacy And Safety Of Advanced Liver Cancer:a Meta-analysis

Objective:Transcatheter arterial chemoembolization(TACE),radiofrequency ablation(RFA),and microwave ablation(MWA)are regarded as effective therapies for treating unresectable hepatocellular carcinoma(HCC).We conducted this study to compare the efficiency and safety of TACE combined with RFA(TR group)or MWA(TM group).Methods:PubMed、Cochrane Library、Web of science、Wanfang Data、CNKI published January 2000 to december 2020 were searched.The primary endpoints were overall complete response(CR),partial response(PR),stable disease(SD),progress disease(PD),alpha fetoprotein(AFP),alanine aminotransferase(ALT),aspartate aminotransferase(AST),survival(OS).After study selection,assessment and data extraction conducted by two reviewers independently,meta-analyses were performed by using the Stata 12.0 software.Results:Fifteen of 1456 retrieved articles were included,with a total of 1265 patients.The results of meta-analyses showed that:TACE Combined with RFA VS TACE Combined with MWA(complete necrosis):RR=0.88,95%CI(0.74,1.04),P=0.138>0.05;TACE Combined with RFA VS TACE Combined with MWA(CR):RR=0.94,95%CI(0.85,1.05),P=0.274>0.05;TACE Combined with RFA VS TACE Combined with MWA(PR):RR=1.08,95%CI(0.90,1.30),P=0.387>0.05;TACE Combined with RFA VS TACE Combined with MWA(SD):RR=0.97,95%CI(0.69,1.36),P=0.857>0.05;TACE Combined with RFA VS TACE Combined with MWA(PD):RR=1.02,95%CI(0.70,1.50),P=0.903>0.05;TACE Combined with RFA VS TACE Combined with MWA(effective rate):RR=1.00,95%CI(0.90,1.12),P=0.959>0.05;TACE Combined with RFA VS TACE Combined with MWA(control rate):RR=1.00,95%CI(0.93,1.10),P=0.903>0.05;TACE Combined with RFA VS TACE Combined with MWA(AFP before):SMD=-0.32,95%CI(-0.79,0.15),P>0.05;TACE Combined with RFA VS TACE Combined with MWA(ALT before):SMD=-0.50,95%CI(-1.40,0.41),P>0.05;TACE Combined with RFA VS TACE Combined with MWA(AST before):SMD=-0.14,95%CI(-0.32,0.05),P>0.05;TACE Combined with RFA VS TACE Combined with MWA(AFP chance):SMD=0.12,95%CI(-0.23,0.48),P>0.05;TACE Combined with RFA VS TACE Combined with MWA(ALT chance):SMD=-0.49,95%CI(-1.55,0.57),P>0.05;TACE Combined with RFA VS TACE Combined with MWA(AST chance):SMD=-0.84,95%CI(-1.39,-0.30),P=0.003<0.05;TACE Combined with RFA VS TACE Combined with MWA(1-year survival rate):RD=0.01,95%CI(-0.04,0.06),P=0.765>0.05;TACE Combined with RFA VS TACE Combined with MWA(2-year survival rate):RD=0.02,95%CI(-0.06,0.10),P=0.620>0.05;TACE Combined with RFA VS TACE Combined with MWA(3-year survival rate):RD=0.10,95%CI(-0.05,0.26),P=0.195>0.05;TACE Combined with RFA VS TACE Combined with MWA(recurrence rate):RD=0.09,95%CI(-0.02,0.19),P=0.10>0.05.When the tumor diameter is ≥5cm,RR=0.57,95%CI(0.34,0.95),P=0.031<0.05.Conclusion:Existing evidence suggests that there is no significant difference in survival time and postoperative recurrence rate between TACE combined with RFA and MWA in the treatment of primary liver cancer.When the tumor diameter was ≥5cm,TACE combined with MWA had a better complete tumor necrosis rate.The combination of TACE and RFA resulted in less liver function impairment.There was no significant difference in the results when ultrasound or CT were used for interventional guidance.For the interventional treatment of advanced liver cancer,the two groups of programs have good clinical efficacy and safety,worthy of further clinical promotion.