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Comparison of combined transarterial chemoembolization and ablations in patients with hepatocellular carcinoma: a systematic review and meta-analysis

  • Special Section: Cross sectional interventions
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Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

This systematic review and meta-analysis compares the efficacy of three combination therapies, including transarterial chemoembolization (TACE) with radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CRA) for the treatment of patients with hepatocellular carcinoma (HCC).

Methods

Online databases, including Scopus, Web of Science, PubMed, Embase, CNKI, Google Scholar, and Cochrane Library were searched.

Results

Forty-two studies with 5468 pooled patients (TACE + RFA: 21 studies with 3398 patients, TACE + MWA:14 studies with 1477 patients, and TACE + CRA: 7 studies with 593 patients) reported combination therapy versus TACE alone. The TACE + MWA subcohort had the best odds of long-term overall survival (OR 4.81, 95% CI 1.44, 16.08, P = 0.011) and objective response rate (OR 3.93, 95% CI 2.34, 6.61, P < 0.001) compared with the other two combination subcohorts. The TACE + RFA and TACE + MWA subcohorts had approximately similar odds of 1-year recurrence-free survival (OR 5.21, 95% CI 2.13, 12.75, P < 0.001 and OR 4.61, 95% CI 1.70, 12.51, P = 0.003, respectively). The disease control rate was similar between the TACE + MWA and TACE + CRA subcohorts (OR 4.01, 95% CI 2.66, 6.04, P < 0.001 and OR 4.05, 95% CI 1.68, 9.74, P = 0.002) but greater than the TACE + RFA subcohort (OR 3.23, 95% CI 2.14, 4.86, P < 0.001).

Conclusion

Overall, the TACE + MWA subcohort had the best efficacy and outcomes, especially for younger patients (less than 60-year-old) with tumor size of ≤ 3 cm, compared with the TACE + RFA or TACE + CRA subcohorts.

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Fig. 1

Adapted from Moher et al. [11]

Fig. 2
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Data availability

The authors declare that they had full access to all of the data in this study. The authors take complete responsibility for the integrity of the data and the accuracy of the data analysis.

Abbreviations

HCC:

Hepatocellular carcinoma

TACE:

Transarterial chemoembolization

RFA:

Radiofrequency ablation

MWA:

Microwave ablation

CRA:

Cryoablation

OS:

Overall survival

RFS:

Recurrence-free survival

RCTs:

Randomized controlled trials

PSM:

Propensity score matching

BCLC:

Barcelona Clinic Liver Cancer

SIR:

Society of Interventional Radiology

CR:

Complete response

PR:

Partial response

SD:

Stable disease

PD:

Progressive disease

ORR:

Objective response rate

DCR:

Disease control rate

NOS:

Newcastle–Ottawa Scale

OR:

Odds ratio

CI:

Confidence intervals

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Acknowledgements

The authors would like to thank the School of Science and Technology of the University of Georgia, Tbilisi, Georgia, for cooperation in data gathering.

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  1. School of Science and Technology, The University of Georgia, 77a, M. Kostava str., 0171, Tbilisi, Georgia

    Pedram Keshavarz

  2. Department of Diagnostic & Interventional Radiology of New Hospitals LTD, Tbilisi, Georgia

    Pedram Keshavarz

  3. Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA), 757 Westwood Plaza, Suite 1638, Los Angeles, CA, 90095, USA

    Pedram Keshavarz & Steven S. Raman

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Keshavarz, P., Raman, S.S. Comparison of combined transarterial chemoembolization and ablations in patients with hepatocellular carcinoma: a systematic review and meta-analysis. Abdom Radiol 47, 1009–1023 (2022). https://doi.org/10.1007/s00261-021-03368-2

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