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Transarterial chemoembolization combined with sorafenib for unresectable hepatocellular carcinoma: a systematic review and meta-analysis

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Abstract

Sorafenib in combination with Transarterial chemoembolization (TACE) is increasingly used in patients with unresectable hepatocellular carcinoma (HCC), but the current evidence is still controversial. The aim of this systematic review was to evaluate the effectiveness and safety of TACE plus sorafenib versus TACE alone for unresectable HCC. We searched PubMed, EMBASE and the Cochrane Library for clinical trials comparing TACE plus sorafenib with TACE alone for unresectable HCC. The study outcomes included overall survival (OS), time to progression (TTP), objective response and adverse events (AEs). Six studies including 1,181 patients were included. Meta-analysis of all studies suggested that the combination therapy group had significant longer OS than TACE group [hazard ratio (HR) = 0.64, 95 % confidence interval (CI) = 0.43–0.97], but the pooled HR of randomized controlled trials (RCTs) failed to achieve statistical significance. For TTP, meta-analysis in both RCTs subgroup and retrospective studies subgroup suggested that combination therapy was superior to TACE group. The combination therapy was also associated with better response to treatment (risk ratio = 1.45, 95 % CI = 1.04–2.02) when both RCTs and retrospective studies were pooled. However, the sorafenib associated AEs were more frequent in the combination therapy group. In conclusion, the combination of TACE and sorafenib is likely to improve OS, TTP and response to treatment when compared with TACE monotherapy. The combination group is also associated with more sorafenib-related AEs.

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Acknowledgments

Man Yang and Jin-Qiu Yuan contributed equally to this study and should be considered as co-first authors. The authors thank Ling Du (The School of Foreign Studies of Xi’an Jiao Tong University, Xi’an, China) for her kind assistance in editing the paper.

Conflict of interest

The authors have no potential conflict of interest to declare.

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Authors and Affiliations

  1. Department of Digestive Interventional Radiology, Xijing Hospital of Digestive Diseases, Fourth Military Medical University, 127 West Changle Road, Xi’an, 710032, China

    Man Yang, Ming Bai & Guo-Hong Han

  2. Division of Epidemiology, School of Public Health and Primary Care, The Chinese University of Hong Kong, 4/F, School of Public Health, Prince of Wales Hospital Shatin, New Territories, Hong Kong, China

    Jin-Qiu Yuan

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  1. Man Yang
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  2. Jin-Qiu Yuan
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  3. Ming Bai
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  4. Guo-Hong Han
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Correspondence to Guo-Hong Han.

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Yang, M., Yuan, JQ., Bai, M. et al. Transarterial chemoembolization combined with sorafenib for unresectable hepatocellular carcinoma: a systematic review and meta-analysis. Mol Biol Rep 41, 6575–6582 (2014). https://doi.org/10.1007/s11033-014-3541-7

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  • DOI: https://doi.org/10.1007/s11033-014-3541-7

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