Effects of Combined TACE and PVC for Primary Hepatocellular Carcinoma: Meta-Analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 SHANGHao , LUHong-wei , ZHANGYa-fei , JIHong ,  LIYi-ming

Department of General Surgery, The Second Affiliated Hospital, College of Medicine, Xi'an Jiaotong University, Xi'an 710004, Shaanxi Province, China;

Corresponding author：

LIYi-ming, Email: liyimingdoc@163.com

Keywords：

Hepatocellular carcinoma; Transarterial chemoembolization; Portal venous chemotherapy; Survival rate; Meta-analysis

DOI：

10.7507/1007-9424.20150310

Video：

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Objective To evaluate the effects of combined TACE and PVC regarding the survival and diseasefree survival rate in hepatocellular carcinoma (HCC) patients. Methods The relevant articles were searchd by a database search of PubMed, EMBASE, Cochrane Library (CENTRAL) Databases, Web of Science, Sciencedirect, National Institute of Health Clinical Trials Database, CNKI, WANFANG Database, and VIP Database. The analysis of the data was performed using Revman 5.1 Software. Results By searching and selecting, a total of ten articles met the inclusion criteria, of which 6 were in the postoperative group, and 4 were in the no-operative group. There were no statistical significance of heterogeneity in each group through subgroup analyzed. The pooled OR showed that combined TACE and PVC could significantly increase the 1-, 2-, and/or 3-year survival and disease-free survival rates compared with TACE alone for HCC patients. The pooled OR and 95% CI of the 1-, 2-and/or 3-year survival and disease-free survival rate, respectively, were as follows:In operative group, 1-year disease-free survival rate 2.09, 1.21-3.61; 3-year disease-free survival rate 3.62, 1.88-6.97; 1-year survival rate 2.25, 1.30-3.87; 3-year survival rate 1.96, 1.20-3.21. In no-perative group:1-year survival rate 3.90, 2.33-6.54; 2-year survival rate 5.30, 1.87-15.06. Conlusions Compared with TACE alone, postoperative adjuvant combined TACE and PVC can significantly increase the 1-, and 3-year survival and disease-free survival rates. For no-perative group, adjuvant combined TACE and PVC can significantly increase the 1-, and 2-year survival rates. Based on the limitations of this meta-analysis (this article is included in the high quality literature less), clinicians should be cautious by using our findings.

Citation： SHANGHao, LUHong-wei, ZHANGYa-fei, JIHong, LIYi-ming. Effects of Combined TACE and PVC for Primary Hepatocellular Carcinoma: Meta-Analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(10): 1192-1199. doi: 10.7507/1007-9424.20150310 Copy

1.	Parkin DM, Bray F, Ferlay J, et al. Estimating the world cancer burden:Globocan 2000. Int J Cancer, 2001, 94(2):153-156.
2.	Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61(2):69-90.
3.	Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008:GLOBOCAN 2008. Int J Cancer, 2010, 127(12):2893-2917.
4.	中华人民共和国卫生部.原发性肝癌诊疗规范(2011版).临床肝胆病杂志, 2011, 27(11):1141-1159.
5.	Liver Cancer Study Group of Japan. Primary liver cancer in Japan. Clinicopathologic features and results of surgical treatment. Ann Surg, 1990, 211(3):277-287.
6.	Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Available from http://handbook.cochrane.org/.
7.	Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in metaanalysis. Available:www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
8.	Li Q, Wang J, Sun Y, et al. Efficacy of postoperative transarterial chemoembolization and portal vein chemotherapy for patients with hepatocellular carcinoma complicated by portal vein tumor thrombosis——a randomized study. World J Surg, 2006, 30(11):2004-2011, discussion 2012-2013.
9.	庄建彬, 王毅军, 杜智, 等.肝动脉插管化疗栓塞联合门静脉化疗对肝细胞癌病人术后生存期的影响.中华肝胆外科杂志, 2010, 16(8):579-581.
10.	张焕虎, 孙胜波, 韩传吉, 等.双途径化疗对合并门静脉癌栓肝癌患者预后的影响(3年随访报告).中华流行病学杂志, 2012, 33(11):1181-1183.
11.	郑盛, 唐映梅, 尤丽英, 等.双途径化疗治疗肝癌并发门静脉癌栓患者对预后的影响.实用肝脏病杂志, 2013, 16(4):351-353.
12.	童颖, 杨甲梅, 徐峰, 等.原发性肝癌伴门静脉癌栓行术后肝动脉化疗栓塞联合门静脉化疗的疗效观察.中华肝胆外科杂志, 2008, 14(12):851-853.
13.	张耀明, 周臻涛, 罗宇峰, 等.原发性肝癌合并门静脉癌栓术后双路介入治疗的效果评价.中国肿瘤外科杂志, 2013, 5(5):283-285.
14.	崔林, 周向荣, 朱扣林, 等.肝动脉化疗栓塞联合门静脉持续灌注化疗治疗原发性肝癌的临床观察.肿瘤基础与临床, 2009, 22(5):409-410.
15.	朱伟, 李小静.介入治疗原发性肝癌合并门静脉癌栓的疗效分析.临床合理用药, 2013, 6(1):10-11.
16.	皮儒先, 陈平, 伍强, 等.介入治疗原发性肝细胞癌合并门静脉癌栓66例的临床分析.胃肠病学和肝病学杂志, 2014, 23(11):1319-1321.
17.	童颖, 杨甲梅, 吴孟超, 等.原发性肝癌伴门静脉癌栓的TACE+ PVC联合治疗.上海:第二军医大学, 2004.
18.	GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specifi c all-cause and causespecific mortality for 240 causes of death, 1990-2013:a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 2015, 385(9963):117-171.
19.	Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med, 2008, 359(4):378-390.
20.	Cheng X, Sun P, Hu QG, et al. Transarterial (chemo) embolization for curative resection of hepatocellular carcinoma:a systematic review and meta-analyses. J Cancer Res Clin Oncol, 2014 Jul, 140(7):1159-1170.
21.	Wallace S, Kan Z, Li C, et al. Hepatic chemoembolization:Clinical and experimental Correlation. Acta Gastroenterol Belg, 2000, 63(2):169-173.
22.	Yamaguchi A, Taniguchi H, Kunishima S, et al. Correlation between angiographically assessed vascularity and blood flow in hepatic metastases in patients with colorectal carcinoma. Cancer, 2000, 89(6):1236-1244.
23.	Hayashi M, Matsui O, Ueda K, et al.Progression to hypervascular hepatocellular carcinoma:correlation with intranodular blood supply evaluated with CT during intraarterial injection of contrast material. Radiology, 2002, 225(1):143-149.
24.	Verslype C, Rosmorduc O, Rougier P, et al. Hepatocellular carcinoma:ESMO-ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2012, 23 Suppl 7:vii41-vii48.
25.	Momosaki S, Nakashima Y, Kojiro M, et al. HBsAg-negative hepatitis B virus infections in hepatitis C virus-associated hepatocellular carcinoma. J Viral Hepat, 2005, 12(3):325-329.
26.	李锦清, 张昌卿, 张亚奇, 等.肝癌切除术后辅助肝动脉栓塞化疗的价值.中国普外基础与临床杂志, 2006, 13(2):135-137.
27.	Fan ST, Lo CM, Liu CL, et al. Hepatectomy for hepatocellular carcinoma:toward zero hospital deaths. Ann Surg, 1999, 229(3):322-330.
28.	Chen XP, Huang ZY. Surgical treatment of hepatocellular carcinoma in China:surgical techniques, indications, and outcomes. Langenbecks Arch Surg, 2005, 390(3):259-265.
29.	Morise Z, Kawabe N, Tomishige H, et al. Recent advances in the surgical treatment of hepatocellular carcinoma. World J Gastroenterol, 2014, 20(39):14381-14392.
30.	Li JQ, Zhang YQ, Zhang WZ, et al. Randomized study of chemoem bolization as an adjuvant therapy for primary liver carcinoma after hepatectomy. J Cancer Res Clin Oncol, 1995, 121(6):364-366.
31.	Cho JY, Paik YH, Park HC, et al. The feasibility of combined transcatheter arterial chemoembolization and radiotherapy for advanced hepatocellular carcinoma. Liver International, 2014, 34(5):795-801.
32.	Yong Li, Zheng YB, Zhao W, et al. Sorafenib in combination with transarterial chemoembolization and radiofrequency ablation in the treatment for unresectable hepatocellular carcinoma. Med Oncol, 2013, 30(4):730.
33.	Watanabe Y, Nakaba H, Taniguchi E, et al. Successful treatment of metastatic hepatocellular carcinoma with sorafenib combined with transcatheter arterial chemoembolization/hepatic arterial infusion chemotherapy. Gan To Kagaku Ryoho, 2014, 41(12):2110-2112.
34.	Hu H, Duan Z, Long X, et al. Comparison of treatment safety and patient survival in elderly versus nonelderly patients with advanced hepatocellular carcinoma receiving sorafenib combined with transarterial chemoembolization:a propensity score matching study. PLoS One, 2015, 10(2):e0117168.
35.	Zhang L, Hu P, Chen X, et al. Transarterial chemoembolization (TACE) plus sorafenib versus TACE for intermediate or advanced stage hepatocellular carcinoma:a meta-analysis. PLoS One, 2014, 9(6):e100305.
36.	Fu QH, Zhang Q, Bai XL, et al. Sorafenib enhances effects of transarterial chemoembolization for hepatocellular carcinoma:a systematic review and meta-analysis. J Cancer Res Clin Oncol, 2014, 140(8):1429-1440.
37.	Liu L, Chen H, Wang M, et al. Combination therapy of sorafenib and TACE for unresectable HCC:a systematic review and metaanalysis. PLoS One, 2014, 9(3):e91124.

1. Parkin DM, Bray F, Ferlay J, et al. Estimating the world cancer burden:Globocan 2000. Int J Cancer, 2001, 94(2):153-156.
2. Jemal A, Bray F, Center MM, et al. Global cancer statistics. CA Cancer J Clin, 2011, 61(2):69-90.
3. Ferlay J, Shin HR, Bray F, et al. Estimates of worldwide burden of cancer in 2008:GLOBOCAN 2008. Int J Cancer, 2010, 127(12):2893-2917.
4. 中华人民共和国卫生部.原发性肝癌诊疗规范(2011版).临床肝胆病杂志, 2011, 27(11):1141-1159.
5. Liver Cancer Study Group of Japan. Primary liver cancer in Japan. Clinicopathologic features and results of surgical treatment. Ann Surg, 1990, 211(3):277-287.
6. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Available from http://handbook.cochrane.org/.
7. Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in metaanalysis. Available:www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
8. Li Q, Wang J, Sun Y, et al. Efficacy of postoperative transarterial chemoembolization and portal vein chemotherapy for patients with hepatocellular carcinoma complicated by portal vein tumor thrombosis——a randomized study. World J Surg, 2006, 30(11):2004-2011, discussion 2012-2013.
9. 庄建彬, 王毅军, 杜智, 等.肝动脉插管化疗栓塞联合门静脉化疗对肝细胞癌病人术后生存期的影响.中华肝胆外科杂志, 2010, 16(8):579-581.
10. 张焕虎, 孙胜波, 韩传吉, 等.双途径化疗对合并门静脉癌栓肝癌患者预后的影响(3年随访报告).中华流行病学杂志, 2012, 33(11):1181-1183.
11. 郑盛, 唐映梅, 尤丽英, 等.双途径化疗治疗肝癌并发门静脉癌栓患者对预后的影响.实用肝脏病杂志, 2013, 16(4):351-353.
12. 童颖, 杨甲梅, 徐峰, 等.原发性肝癌伴门静脉癌栓行术后肝动脉化疗栓塞联合门静脉化疗的疗效观察.中华肝胆外科杂志, 2008, 14(12):851-853.
13. 张耀明, 周臻涛, 罗宇峰, 等.原发性肝癌合并门静脉癌栓术后双路介入治疗的效果评价.中国肿瘤外科杂志, 2013, 5(5):283-285.
14. 崔林, 周向荣, 朱扣林, 等.肝动脉化疗栓塞联合门静脉持续灌注化疗治疗原发性肝癌的临床观察.肿瘤基础与临床, 2009, 22(5):409-410.
15. 朱伟, 李小静.介入治疗原发性肝癌合并门静脉癌栓的疗效分析.临床合理用药, 2013, 6(1):10-11.
16. 皮儒先, 陈平, 伍强, 等.介入治疗原发性肝细胞癌合并门静脉癌栓66例的临床分析.胃肠病学和肝病学杂志, 2014, 23(11):1319-1321.
17. 童颖, 杨甲梅, 吴孟超, 等.原发性肝癌伴门静脉癌栓的TACE+ PVC联合治疗.上海:第二军医大学, 2004.
18. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specifi c all-cause and causespecific mortality for 240 causes of death, 1990-2013:a systematic analysis for the Global Burden of Disease Study 2013. Lancet, 2015, 385(9963):117-171.
19. Llovet JM, Ricci S, Mazzaferro V, et al. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med, 2008, 359(4):378-390.
20. Cheng X, Sun P, Hu QG, et al. Transarterial (chemo) embolization for curative resection of hepatocellular carcinoma:a systematic review and meta-analyses. J Cancer Res Clin Oncol, 2014 Jul, 140(7):1159-1170.
21. Wallace S, Kan Z, Li C, et al. Hepatic chemoembolization:Clinical and experimental Correlation. Acta Gastroenterol Belg, 2000, 63(2):169-173.
22. Yamaguchi A, Taniguchi H, Kunishima S, et al. Correlation between angiographically assessed vascularity and blood flow in hepatic metastases in patients with colorectal carcinoma. Cancer, 2000, 89(6):1236-1244.
23. Hayashi M, Matsui O, Ueda K, et al.Progression to hypervascular hepatocellular carcinoma:correlation with intranodular blood supply evaluated with CT during intraarterial injection of contrast material. Radiology, 2002, 225(1):143-149.
24. Verslype C, Rosmorduc O, Rougier P, et al. Hepatocellular carcinoma:ESMO-ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol, 2012, 23 Suppl 7:vii41-vii48.
25. Momosaki S, Nakashima Y, Kojiro M, et al. HBsAg-negative hepatitis B virus infections in hepatitis C virus-associated hepatocellular carcinoma. J Viral Hepat, 2005, 12(3):325-329.
26. 李锦清, 张昌卿, 张亚奇, 等.肝癌切除术后辅助肝动脉栓塞化疗的价值.中国普外基础与临床杂志, 2006, 13(2):135-137.
27. Fan ST, Lo CM, Liu CL, et al. Hepatectomy for hepatocellular carcinoma:toward zero hospital deaths. Ann Surg, 1999, 229(3):322-330.
28. Chen XP, Huang ZY. Surgical treatment of hepatocellular carcinoma in China:surgical techniques, indications, and outcomes. Langenbecks Arch Surg, 2005, 390(3):259-265.
29. Morise Z, Kawabe N, Tomishige H, et al. Recent advances in the surgical treatment of hepatocellular carcinoma. World J Gastroenterol, 2014, 20(39):14381-14392.
30. Li JQ, Zhang YQ, Zhang WZ, et al. Randomized study of chemoem bolization as an adjuvant therapy for primary liver carcinoma after hepatectomy. J Cancer Res Clin Oncol, 1995, 121(6):364-366.
31. Cho JY, Paik YH, Park HC, et al. The feasibility of combined transcatheter arterial chemoembolization and radiotherapy for advanced hepatocellular carcinoma. Liver International, 2014, 34(5):795-801.
32. Yong Li, Zheng YB, Zhao W, et al. Sorafenib in combination with transarterial chemoembolization and radiofrequency ablation in the treatment for unresectable hepatocellular carcinoma. Med Oncol, 2013, 30(4):730.
33. Watanabe Y, Nakaba H, Taniguchi E, et al. Successful treatment of metastatic hepatocellular carcinoma with sorafenib combined with transcatheter arterial chemoembolization/hepatic arterial infusion chemotherapy. Gan To Kagaku Ryoho, 2014, 41(12):2110-2112.
34. Hu H, Duan Z, Long X, et al. Comparison of treatment safety and patient survival in elderly versus nonelderly patients with advanced hepatocellular carcinoma receiving sorafenib combined with transarterial chemoembolization:a propensity score matching study. PLoS One, 2015, 10(2):e0117168.
35. Zhang L, Hu P, Chen X, et al. Transarterial chemoembolization (TACE) plus sorafenib versus TACE for intermediate or advanced stage hepatocellular carcinoma:a meta-analysis. PLoS One, 2014, 9(6):e100305.
36. Fu QH, Zhang Q, Bai XL, et al. Sorafenib enhances effects of transarterial chemoembolization for hepatocellular carcinoma:a systematic review and meta-analysis. J Cancer Res Clin Oncol, 2014, 140(8):1429-1440.
37. Liu L, Chen H, Wang M, et al. Combination therapy of sorafenib and TACE for unresectable HCC:a systematic review and metaanalysis. PLoS One, 2014, 9(3):e91124.

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Effects of Combined TACE and PVC for Primary Hepatocellular Carcinoma: Meta-Analysis

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