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Yang et al. Hepatoma Res 2019;5:13 I http://dx.doi.org/10.20517/2394-5079.2019.04 Page 7 of 9

Figure 8. Meta-analysis of funnel plots of tumor response rate

Based on our meta-analysis, combination therapy of TACE with RFA is an effective method for HCC
treatment. HCC is mainly supplied by the hepatic artery. Even when the hepatic artery blood flow is blocked
by TACE, the thermal coagulation effect of RFA is not affected. Thus, it increases the area of necrosis
induced by RFA. Additionally, the effects of expanded ablation zones and anticancer agents on liver cancer
[26]
cells during treatment may reduce the chance of tumor recurrence .
This meta-analysis has some limitations. Firstly, the complications and adverse reactions of combination
therapy cannot be assessed fully due to the lack of original research data. Therefore, future studies can
further evaluate these indicators. Secondly, the sample size of this current meta-analysis is limited; large-
scale randomized controlled trials of long-term follow-up are needed to validate this result.

In conclusion, our study suggests that TACE combined with RFA is superior to TACE alone in the treatment
of HCC larger than 5 cm. Patients in the combined treatment group showed significantly increased tumor
response rate and survival rates compared with those treated with TACE alone. This article provided clinical
and systematic evidence for the improved treatment of HCC larger than 5 cm.

DECLARATIONS
Authors’ contributions
Design of the work: Yang Y, Long Y, Zhang WL
Acquisition, analysis of data: Yang Y, Lv ZM, Yan M
Wrote this paper: Yang Y, Zhang HX, Long Y, Zhang WL
Revised the manuscripts: All authors

Availability of data and materials
All data did by the authors listed in this paper.

Financial support and sponsorship
This study was funded by National Natural Science Foundations of China (81773488 and 8177110260).

Conflicts of interest
All authors declared that there are no conflicts of interest.