Meta-analysis of radiofrequency ablation in combination with transarterial chemoembolization for hepatocellular carcinoma

Abstract

Aim: To compare radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) with RFA monotherapy in hepatocellular carcinoma (HCC).

Methods: We searched PubMed, Medline, Embase and Chinese databases (CBMdisc and Wanfang data) for randomized controlled trails comparing RFA plus TACE and RFA alone for treatment of HCC from January 2000 to December 2012. The overall survival rate, recurrence-free survival rate, tumor progression rate, and safety were analyzed and compared. The analysis was conducted on dichotomous outcomes and the standard meta-analytical techniques were used. Pooled odds ratios (ORs) with 95%CIs were calculated using either the fixed-effects or random-effects model. For each meta-analysis, the χ(2) and I(2) tests were first calculated to assess the heterogeneity of the included trials. For P < 0.05 and I(2) > 50%, the assumption of homogeneity was deemed invalid, and the random-effects model was used; otherwise, data were assessed using the fixed-effects model. All statistical analysis was conducted using Review manager (version 4.2.2.) from the Cochrane collaboration.

Results: Eight randomized controlled trials were identified as eligible for inclusion in this analysis and included 598 patients with 306 treated with RFA plus TACE and 292 with RFA alone. Our data analysis indicated that RFA plus TACE was associated a significantly higher overall survival rate (OR1-year = 2.96, 95%CI: 1.84-7.74, P < 0.001; OR2-year = 3.72, 95%CI: 1.24-11.16, P = 0.02; OR3-year = 2.65, 95%CI: 1.81-3.86, P < 0.001) and recurrence-free survival rate (OR3-year = 3.00, 95%CI: 1.75-5.13, P < 0.001; OR5-year = 2.26, 95%CI: 1.43-3.57, P = 0.0004) vs that of RFA alone. The tumor progression rate in patients treated with RFA alone was higher than that of RFA plus TACE (OR = 0.60, 95%CI: 0.42-0.88, P = 0.008) and there was no significant difference on major complications between two different kinds of treatment (OR = 1.20, 95%CI: 0.31-4.62, P = 0.79). Additionally, the meta-analysis data of subgroups revealed that the survival rate was significantly higher in patients with intermediate- and large-size HCC underwent RFA plus TACE than in those underwent RFA monotherapy; however, there was no significant difference between RFA plus TACE and RFA on survival rate for small HCC.

Conclusion: The combination of RFA with TACE has advantages in improving overall survival rate, and provides better prognosis for patients with intermediate- and large-size HCC.

Keywords: Hepatocellular carcinoma; Meta-analysis; Radiofrequency ablation; Transcatheter arterial chemoembolization.

Figure 1

Flow chart of searching strategy for study inclusion. RFA: Radiofrequency ablation; TACE: Transcatheter arterial chemoembolization.

Figure 2

Comparison of combination of radiofrequency ablation and transcatheter arterial chemoembolization with radiofrequency ablation alone for hepatocellular carcinoma in terms of overall survival rates (A-D) and recurrence-free survival rates (E-G). A, E: Meta-analysis of 1-year results; B: Meta-analysis of 2-year results; C, F: Meta-analysis of 3-year results; D, G: Meta-analysis of 5-year results. RFA: Radiofrequency ablation; TACE: Transcatheter arterial chemoembolization; OR: Odds ratio.

Figure 3

Comparison of combination of radiofrequency ablation and transcatheter arterial chemoembolization with radiofrequency ablation alone for hepatocellular carcinoma in terms of tumor progression rate (A) and major complications (B). RFA: Radiofrequency ablation; TACE: Transcatheter arterial chemoembolization; OR: Odds ratio.

Figure 4

Comparison of combination of radiofrequency ablation and transcatheter arterial chemoembolization with radiofrequency ablation alone for small hepatocellular carcinoma in terms of survival rates. A, B: Tumor size ≤ 3 cm; C-F: 3 cm < tumor size ≤ 5 cm; G, H: Tumor size > 5 cm; A, C, F: Meta-analysis of 1-year results; B, D, G: Meta-analysis of 3-year results; E: Meta-analysis of 5-year results.

Figure 5

Funnel plot in the analysis of the effect of 1-year overall survival rate. OR: Odds ratio.