Systematic review and meta-analysis of the efficacy and safety of high-intensity focused ultrasound combined with transarterial chemoembolization and transarterial chemoembolization alone in the treatment of liver cancer

BACKGROUND: High-intensity focused ultrasound (HIFU) and transarterial chemoembolization (TACE) have been shown to be effective in the treatment of malignant tumors such as hepatocellular carcinoma. In recent years, HIFU combined with TACE has been frequently reported, but researchers have not yet reached a uniform conclusion on the efficacy and safety of this treatment modality. METHODS: The Chinese National Knowledge Infrastructure (CNKI), China Biomedical Literature Database, Cochrane Library, MEDLINE, and Embase databases were searched using the terms “randomized controlled trial (RCT)”, “liver cancer”, “transarterial chemoembolization”, “TACE”, “high intensity focused ultrasound”, “HIFU”, “HIFU combined with TACE”, and “efficacy analysis”. Studies were included in accordance with the PICOS principle, and risk of bias was assessed in randomized controlled trials in accordance with the Cochrane Manual for Systematic Evaluation of Interventions. Rev Man 5.3 and Stata 13 were employed for meta-analysis. RESULTS: Six randomized controlled trials with a total sample size of 488 were included in this study. Of these studies, 5 described a random allocation (RA) method, 4 described allocation sequence concealment, and 4 used a blind method for the allocation of study subjects. The results of the meta-analysis showed that the 1-year [odds ratio (OR) =3.13, 95% CI: 1.92, 5.11, P<0.00001], 2-year (OR =3.38, 95% CI: 1.71, 6.66, P=0.0004), and 5-year (OR =2.15, 95% CI: 1.02, 4.55, P=0.04) survival rates (SRs) of patients treated with HIFU + TACE were significantly better than those of patients treated with TACE alone. The total effective rate (TER) of patients treated with HIFU + TACE (OR =3.61, 95% CI: 2.14, 6.08, P<0.00001) was significantly better than that of patients treated with TACE alone. Compared with TACE alone, HIFU combined with TACE significantly reduced the incidence of postoperative adverse reactions (OR= 0.57, 95% CI: 0.34, 9.96, P=0.03). DISCUSSION: Meta-analysis was adopted in this study, and it was found that compared with TACE alone, HIFU combined with TACE in the treatment of LC had better efficacy, higher prognosis and survival rate, and lower incidence of adverse reactions. However, due to the limited sample size of the study, there was some risk of bias in the findings.