Meta Analysis of the Combination of TACE and Resection for Treatment of HCC in Chinese

Objective To evaluate the transarterial chemoembolization（TACE） in preventing recurrence and improving Chinese patient’s survival after curative resection for hepatocellular carcinoma （HCC） by using a meta-analysis. Methods Relevant randomized controlled trials （RCTs）related to TACE treatment after HCC resection were searched using PubMed, Cochrane Library, ISI Web of Knowledge, CBM, CNKI and VIP from inception to September 2014. RevMan5.0 was applied for the meta-analysis. After heterogeneity analysis, pooled risk ratio （RR） with 95% confidence interval （95%CI） using both fixed and random effect models were estimated. Sensitivity analyses were used for evaluating the robustness of the result. Publication bias was assessed by map funnel method. Results A total of 14 RCTs involving 1 029 patients were included, 467 cases of patients with hepatectomy plus TACE, 462 patients with hepatectomy alone. All were evaluated by the Jadad scale, 4 items of high quality research, 10 low quality research. Compared with hepatectomy only, the RR （95%CI） of the recurrence at 1, 2 and 3 years after the resection in case group were 0.48 （95%CI 0.37~0.63）, 0.62（0.50~0.77） and 0.50 （0.45~0.84）, which all had statistic significance reflecting that postoperative adjuvant TACE could reduce recurrence rate. Postoperative adjuvant TACE seems to improve the overall survival （OS） rate for 1 year, 2 years and 3 years than hepatectomy only, RR and 95%CI: 1.37 （1.23~1.54）, 1.66（1.36~2.04） and 1.36 （1.51~2.77）, But the differences of disease-free survival （DFS） rate between the two groups were not significance. Side effects and severe adverse events related with TACE were mainly liver function impairment, fever and gastrointestinal symptoms. Conclusions Based on the results of this meta analysis, postoperative adjuvant TACE could reduce the recurrence rate and improve the OS of HCC, but may not DFS of patients. However, more RCTs with high quality are still needed to assess and verify the efficacy and safety further.