Meta-Analysis
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Dec 26, 2015; 3(6): 295-303
Published online Dec 26, 2015. doi: 10.13105/wjma.v3.i6.295
Radiofrequency ablation with or without transarterial chemoembolization for hepatocellular carcinoma: A systematic review and meta-analysis
Ming-Zheng Hu, Shao-Fang Li
Ming-Zheng Hu, Shao-Fang Li, Institute of Hepatopancreatobiliary Surgery, Yichang Central People’s Hospital, China Three Gorges University, Yichang 443000, Hubei Province, China
Shao-Fang Li, Department of Gastroenterology, Zhijiang People’s Hospital, Yichang 443200, Hubei Province, China
Author contributions: Hu MZ and Li SF conceived and designed the study, acquired, analyzed and interpreted data, and drafted the article; both authors have approved the final version to be published
Supported by Hubei Provincial Health and Family Planning Scientific Research Project, No. QJX2012-42.
Conflict-of-interest statement: The authors declared that there is no conflict of interest in this study.
Data sharing statement: No additinal data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Ming-Zheng Hu, Institute of Hepatopancreatobiliary Surgery, Yichang Central People’s Hospital, China Three Gorges University, No. 183, Yiling Road, Yichang 443000, Hubei Province, China. hmz08@sina.com.cn
Telephone: +86-71-76485275 Fax: +86-71-76482302
Received: May 14, 2015
Peer-review started: May 15, 2015
First decision: June 19, 2015
Revised: August 27, 2015
Accepted: November 30, 2015
Article in press: December 3, 2015
Published online: December 26, 2015
Processing time: 224 Days and 10 Hours
Abstract

AIM: To determine whether combined transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) improve overall and recurrence-free survival (RFS) compared with RFA alone.

METHODS: We reviewed randomized clinical trials (RCTs) comparing overall survival rate as well as recurrence-free rate for hepatocellular carcinoma (HCC) between TACE-RFA therapy and RFA alone published before April 2015 by conducting a systematic review and meta-analysis. Eligible studies were identified by searching PubMed and EMBASE up to April 2015. Additional studies were retrieved via China Medical Collections, Google Scholar or a hand review of the reference lists of the retrieved articles. The summarized relative risks (RRs) with their 95%CIs were estimated using random-effects model. I2 statistic was calculated to measure the heterogeneity of RRs across studies and Cochran’s Q test was used to test the statistical significance accordingly. Publication bias was assessed primarily based on visual assessment using a funnel plot, and secondly by using Egger’s regression asymmetry test or Begg’s rank correlation test as appropriate. Meta-regression was implemented to examine potential effect modifiers.

RESULTS: Nine single-center RCTs conducted in China and Japan were included, with a total of 618 patients with HCC; 321 of whom (51.9%) received TACE/RFA therapy and 297 received RFA alone. The pooled RRs with corresponding CIs comparing combined TACE/RFA to RFA alone were 1.12 (1.004-1.26) and 1.20 (1.02-1.41) for 1-year and 3-year survival rates, respectively. Similar positive associations were found for 1-year (1.19; 1.05-1.35) and 3-year (1.44; 1.00-2.07) RFS. The beneficial effect was more evident in patients with medium-sized (3-5 cm) tumors and among the Chinese population.

CONCLUSION: Combined TACE/RFA has a beneficial effect on survival and recurrence rates compared with RFA alone, especially for medium-sized HCC and among Chinese patients.

Keywords: Radiofrequency ablation; Hepatocellular carcinoma; Transarterial chemoembolization; Meta-analysis; Randomized clinical trial

Core tip: A systematic review and meta-analysis were conducted to determine whether combined transarterial chemoembolization (TACE) and radiofrequency ablation (RFA) improve overall and recurrence-free survival compared with RFA alone. Nine single-center randomized controlled trials were included, with a total of 618 patients with hepatocellular carcinoma (HCC), 321 of whom (51.9%) received TACE/RFA and 297 received RFA alone. We found that combined TACE/RFA has a beneficial effect on survival and recurrence rates compared with RFA alone, especially for medium-sized (3-5 cm) HCC and among Chinese patients.