Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2024; 16(6): 2793-2803
Published online Jun 15, 2024. doi: 10.4251/wjgo.v16.i6.2793
Meta-analysis of transarterial chemoembolization combined with cryoablation vs transarterial chemoembolization alone for ≥ 5 cm hepatocellular carcinoma
Jie-Fei Cheng, Qiu-Lian Sun, Ling Tang, Xin-Jian Xu, Xiang-Zhong Huang
Jie-Fei Cheng, Department of Radiology, The Fifth People’s Hospital of Taizhou, Taizhou 225300, Jiangsu Province, China
Qiu-Lian Sun, Department of Radiology, The Fifth People’s Hospital of Suzhou, Suzhou 215100, Jiangsu Province, China
Ling Tang, Department of Radiology, The Fourth People’s Hospital of Taizhou, Taizhou 225300, Jiangsu Province, China
Xin-Jian Xu, Xiang-Zhong Huang, Department of Interventional Radiology, Jiangyin People Hospital, Jiangyin 214400, Jiangsu Province, China
Co-first authors: Jie-Fei Cheng and Qiu-Lian Sun.
Co-corresponding authors: Xin-Jian Xu and Xiang-Zhong Huang.
Author contributions: Cheng JF and Sun QL are contributed equally to this work and should be considered co-first authors. Cheng JF made significant contributions to data collection and initial drafting of the manuscript; Sun QL was responsible for literature review, study design, and collaborated closely with other authors; Cheng JF, Sun QL, and Tang L contributed to the data analysis; Tang L provided valuable guidance and suggestions throughout the research process, and contributed to the interpretation of findings; Xu XJ is the corresponding author of this study and as the principal investigator, made significant contributions in research concept generation, guidance, supervision, and manuscript review and revision. His expertise and skills are of great significance for the accuracy and reliability of the research findings; Huang XZ is a co-corresponding author of this study. He was responsible for writing critical sections of the manuscript and provided effective technical support throughout the research process. His efforts played a key role in the smooth progress of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Jian Xu, MD, Doctor, Department of Interventional Radiology, Jiangyin People Hospital, No. 3 Yingrui Road, Jiangyin 214400, Jiangsu Province, China. qiezinb@126.com
Received: December 11, 2023
Revised: March 1, 2024
Accepted: April 16, 2024
Published online: June 15, 2024
Processing time: 187 Days and 1.3 Hours
Abstract
BACKGROUND

Hepatocellular carcinoma (HCC) ranks sixth globally in cancer incidence and third in mortality rates. Unfortunately, over 70% of HCC patients forego the opportunity for curative surgery or liver transplantation due to inadequate physical examinations, poor physical condition, and limited organ availability upon diagnosis. Clinical guidelines endorse transarterial chemoembolization (TACE) as the frontline treatment for intermediate to advanced-stage HCC. Cryoablation (CRA) is an emerging local ablative therapy increasingly used in HCC management. Recent studies suggest that combining CRA with TACE offers complementary and synergistic effects, potentially improving long-term survival rates. However, the superiority of combined TACE + CRA therapy over TACE alone for HCC lesions equal to or exceeding 5 cm requires further investigation.

AIM

To compare the efficacy and safety of TACE combined with CRA vs TACE alone in the treatment of HCC with a diameter of ≥ 5 cm.

METHODS

PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and VIP databases were searched to retrieve all relevant studies on TACE and CRA up to July 2022. Meta-analysis was performed using RevMan 5.3 software.

RESULTS

After screening according to the inclusion and exclusion criteria, 6 articles were included, including 2 randomized controlled trials and 4 nonrandomized controlled trials, with a total of 575 patients included in the meta-analysis. The results showed that the objective response rate [odds ratio (OR) = 2.56, 95% confidence interval (CI):1.66-3.96, P < 0.0001), disease control rate (OR = 3.03, 95%CI: 1.88-4.89, P < 0.00001), 1-year survival rate (OR = 3.79, 95%CI: 2.50-5.76, P < 0.00001), 2-year survival rate (OR = 2.34, 95%CI: 1.43-3.85, P = 0.0008), and 3-year survival rate (OR = 3.34, 95%CI: 1.61-6.94, P = 0.001) were all superior to those of the control group; the postoperative decrease in alpha-fetoprotein value (OR = 295.53, 95%CI: 250.22-340.85, P < 0.0001), the postoperative increase in CD4 value (OR = 10.59, 95%CI: 8.78-12.40, P < 0.00001), and the postoperative decrease in CD8 value (OR = 6.47, 95%CI: 4.44-8.50, P < 0.00001) were also significantly higher than those in the TACE-alone treatment group.

CONCLUSION

Compared with TACE-alone treatment, TACE + CRA combined treatment not only improves the immune function of HCC patients with a diameter of ≥ 5 cm, but also enhances the therapeutic efficacy and long-term survival rate, without increasing the risk of complications. Therefore, TACE + CRA combined treatment may be a more recommended treatment for patients with HCC with a diameter of ≥ 5 cm.

Keywords: Hepatic cancer, Cryoablation, Chemoembolization, Transarterial chemoembolization, Meta analysis

Core Tip: To compare the efficacy and safety of transarterial chemoembolization (TACE) combined with cryoablation (CRA) vs TACE alone in the treatment of hepatocellular carcinoma (HCC) with a diameter of ≥ 5 cm. Compared with TACE-alone treatment, TACE + CRA combined treatment not only improves the immune function of HCC patients with a diameter of ≥ 5 cm, but also enhances the therapeutic efficacy and long-term survival rate, without increasing the risk of complications. Therefore, TACE + CRA combined treatment may be a more recommended treatment for patients with HCC with a diameter of ≥ 5 cm.