Page 156 - Read Online

Page 2 of 9 Yang et al. Hepatoma Res 2019;5:13 I http://dx.doi.org/10.20517/2394-5079.2019.04

Keywords: Transarterial chemoembolization; radiofrequency ablation; hepatocellular carcinoma; meta-analysis

INTRODUCTION
Hepatocellular carcinoma (HCC) is one of the most common and malignant tumor in the world, with an
[1]
annual incidence of over 700,000 patients worldwide . As the symptoms of HCC often do not present in the
early stages, most patients are in the middle and late stage at the time of diagnosis, among which only 20%-30%
[2]
of patients have the chance to receive surgical resection or liver transplantation . Patients with large tumors
that cannot undergo surgical resection or liver transplantation are usually offered comprehensive treatment
[3,4]
based on transarterial chemoembolization (TACE) . However, the long-term outcome of treating HCC
[5,6]
with TACE alone is not ideal, due to incomplete tumor necrosis . Studies have shown that TACE combined
[7,8]
with RFA in the treatment of HCC is more efficacious than either TACE or RFA alone . Nevertheless, some
studies have reported contradictory results [9,10] . Of note, the sample sizes of these studies are small and the
observations need further validation. Additionally, it is unknown whether this combined treatment is more
effective than single modality treatment for HCC tumors larger than 5 cm.

Therefore, in order to determine whether TACE plus RFA is more effective in patients with HCC than TACE
alone, this current meta-analysis was performed to compare the efficacy of TACE plus RFA with TACE
monotherapy. This comparison is expected to provide more convincing evidence for HCC patients having to
choose between two methods. In this study, the clinical efficacy of TACE combined with RFA was compared
with that of TACE alone in the treatment of HCC larger than 5 cm, to provide evidence to guide clinical
practice.

METHODS
Search methods and quality assessment
As of October 22, 2018, randomized controlled trials (RCT) comparing the clinical efficacy of TACE with
RFA vs. TACE alone in the treatment of HCC was performed using a computerized search on PUBMED,
Chinese Journal Full-text Database (CKNI), and CBM. Search terms include “Liver Neoplasms/therapy”
[Mesh], “Chemoembolization, Therapeutic” [Mesh], “TACE”, “Radiofrequency ablation”. The literature
language is limited to Chinese and English.

Evaluation of literature quality (including literature data extraction and quality scoring) was carried out
by the authors. According to the Jadad quality standard, the scoring method is as follows. Whether it is
randomly assigned: 2 points is awarded for detailed random allocation, 1 point when it was not specifically
described, and 0 point if it was not mentioned. Whether analysis was blinded, 2 points for double-blind, 1
point for blinding without detailed description, 0 point for open trial. Whether there was a detailed reason
for loss of follow-up: 1 point for yes, 0 point for no. High quality research literatures are those that received 3
to 5 points; and low quality literatures are those that received 0 to 2 points.

Inclusion criteria
Literature reports were eligible for inclusion if: (1) they are domestic or international publications, that
compared the clinical efficacy of TACE combined with RFA vs. TACE alone in the treatment of intermediate
and advanced staged HCC; (2) they report complete case data; (3) the results of the study include tumor
response rate; (4) the maximum diameter of tumor lesions is greater than 5 cm; (5) the clinical study design
is consistent with that of a RCT.

Exclusion criteria
Literature reports were excluded if: (1) they are review articles or case reports, are of poor literature quality
as evaluated by the above method, or have no proper controls; (2) they are animal studies; (3) there are