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Transarterial Chemoembolization in Combination with Local Therapies for Hepatocellular Carcinoma: A Meta-Analysis
BACKGROUND: In previous randomized trials, transarterial chemoembolization (TACE) has shown an improvement of survival rate in hepatocellular carcinoma (HCC) when combined with radiofrequency ablation (RFA), percutaneous ethanol injection (PEI) or other therapies. The aim of this meta-analysis was t...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Public Library of Science
2013
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701086/ https://www.ncbi.nlm.nih.gov/pubmed/23844203 http://dx.doi.org/10.1371/journal.pone.0068453 |
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author | Liao, Mingheng Huang, Jiwei Zhang, Tao Wu, Hong |
author_facet | Liao, Mingheng Huang, Jiwei Zhang, Tao Wu, Hong |
author_sort | Liao, Mingheng |
collection | PubMed |
description | BACKGROUND: In previous randomized trials, transarterial chemoembolization (TACE) has shown an improvement of survival rate in hepatocellular carcinoma (HCC) when combined with radiofrequency ablation (RFA), percutaneous ethanol injection (PEI) or other therapies. The aim of this meta-analysis was to evaluate the effectiveness of combination therapy of TACE with RFA, PEI, radiotherapy (RT), three-dimensional conformal radiation therapy (3D-CRT) or High-Intensity Focused Ultrasound (HIFU). METHODS: Randomized or nonrandomized studies comparing TACE combined with RFA, PEI, RT, 3D-CRT or HIFU with TACE alone for HCC were included. Meta-analysis was performed using a fix-effects model in RCTs and a random-effects model among the observational studies. RESULTS: 10 randomized trials and 18 observational studies matched the selection criteria, including 2497 patients (682 in RCTs, 1815 in non-RCTs). Meta-analysis of RCTs showed that the combination of TACE and PEI ((RR)(1) (-)year=1.10, 95%CI=0.99-1.22, p=0.073; (RR)(3) (-)year=2.32, 95%CI=1.52-3.53, p<0.001), TACE+RT ((RR)(1) (-)year=1.37, 95%CI=1.11-1.70, p=0.004; (RR)(3) (-)year=2.32, 95%CI=1.44-3.75, p=0.001) were associated with higher survival rates. The results of observational studies were in good consistency with that of RCTs. Furthermore, TACE plus 3D-CRT ((RR)(1) (-)year=1.22, 95%CI=1.06-1.41, p=0.005; (RR)(3) (-)year=2.05, 95%CI=1.48-2.84, p<0.001) and TACE plus HIFU ((RR)(1) (-)year=1.16, 95%CI=1.01-1.33, p=0.033; (RR)(3) (-)year=1.66, 95%CI=1.12-2.45, p=0.011) have introduced marked survival benefit when pooling results from observational studies. CONCLUSIONS: This meta-analysis demonstrated that TACE combined with local treatments, especially PEI, HIFU or 3D-CRT could improve the overall survival status than performing TACE alone. Importantly, these results need to be validated in further high-quality clinical trials. |
format | Online Article Text |
id | pubmed-3701086 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-37010862013-07-10 Transarterial Chemoembolization in Combination with Local Therapies for Hepatocellular Carcinoma: A Meta-Analysis Liao, Mingheng Huang, Jiwei Zhang, Tao Wu, Hong PLoS One Research Article BACKGROUND: In previous randomized trials, transarterial chemoembolization (TACE) has shown an improvement of survival rate in hepatocellular carcinoma (HCC) when combined with radiofrequency ablation (RFA), percutaneous ethanol injection (PEI) or other therapies. The aim of this meta-analysis was to evaluate the effectiveness of combination therapy of TACE with RFA, PEI, radiotherapy (RT), three-dimensional conformal radiation therapy (3D-CRT) or High-Intensity Focused Ultrasound (HIFU). METHODS: Randomized or nonrandomized studies comparing TACE combined with RFA, PEI, RT, 3D-CRT or HIFU with TACE alone for HCC were included. Meta-analysis was performed using a fix-effects model in RCTs and a random-effects model among the observational studies. RESULTS: 10 randomized trials and 18 observational studies matched the selection criteria, including 2497 patients (682 in RCTs, 1815 in non-RCTs). Meta-analysis of RCTs showed that the combination of TACE and PEI ((RR)(1) (-)year=1.10, 95%CI=0.99-1.22, p=0.073; (RR)(3) (-)year=2.32, 95%CI=1.52-3.53, p<0.001), TACE+RT ((RR)(1) (-)year=1.37, 95%CI=1.11-1.70, p=0.004; (RR)(3) (-)year=2.32, 95%CI=1.44-3.75, p=0.001) were associated with higher survival rates. The results of observational studies were in good consistency with that of RCTs. Furthermore, TACE plus 3D-CRT ((RR)(1) (-)year=1.22, 95%CI=1.06-1.41, p=0.005; (RR)(3) (-)year=2.05, 95%CI=1.48-2.84, p<0.001) and TACE plus HIFU ((RR)(1) (-)year=1.16, 95%CI=1.01-1.33, p=0.033; (RR)(3) (-)year=1.66, 95%CI=1.12-2.45, p=0.011) have introduced marked survival benefit when pooling results from observational studies. CONCLUSIONS: This meta-analysis demonstrated that TACE combined with local treatments, especially PEI, HIFU or 3D-CRT could improve the overall survival status than performing TACE alone. Importantly, these results need to be validated in further high-quality clinical trials. Public Library of Science 2013-07-03 /pmc/articles/PMC3701086/ /pubmed/23844203 http://dx.doi.org/10.1371/journal.pone.0068453 Text en © 2013 Liao et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited. |
spellingShingle | Research Article Liao, Mingheng Huang, Jiwei Zhang, Tao Wu, Hong Transarterial Chemoembolization in Combination with Local Therapies for Hepatocellular Carcinoma: A Meta-Analysis |
title | Transarterial Chemoembolization in Combination with Local Therapies for Hepatocellular Carcinoma: A Meta-Analysis |
title_full | Transarterial Chemoembolization in Combination with Local Therapies for Hepatocellular Carcinoma: A Meta-Analysis |
title_fullStr | Transarterial Chemoembolization in Combination with Local Therapies for Hepatocellular Carcinoma: A Meta-Analysis |
title_full_unstemmed | Transarterial Chemoembolization in Combination with Local Therapies for Hepatocellular Carcinoma: A Meta-Analysis |
title_short | Transarterial Chemoembolization in Combination with Local Therapies for Hepatocellular Carcinoma: A Meta-Analysis |
title_sort | transarterial chemoembolization in combination with local therapies for hepatocellular carcinoma: a meta-analysis |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701086/ https://www.ncbi.nlm.nih.gov/pubmed/23844203 http://dx.doi.org/10.1371/journal.pone.0068453 |
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