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. 2022 Jan 4;1(1):CD013345.
doi: 10.1002/14651858.CD013345.pub2.

The combination of transcatheter arterial chemoembolisation (TACE) and thermal ablation versus TACE alone for hepatocellular carcinoma

BoZhi Liu  1 , YongChao Zhang  1 , Hui Chen  2 , Wei Li  1 , Emmanuel Tsochatzis  3
Affiliations

The combination of transcatheter arterial chemoembolisation (TACE) and thermal ablation versus TACE alone for hepatocellular carcinoma

BoZhi Liu et al. Cochrane Database Syst Rev. .

Abstract

Background: Hepatocellular carcinoma is the sixth most common cancer worldwide. Hepatic resection is regarded as the curative therapy for hepatocellular carcinoma. However, only about 20% of people with hepatocellular carcinoma are candidates for resection, which highlights the importance of effective nonsurgical therapies. Until now, transcatheter arterial chemoembolisation (TACE) is the most common palliative therapy for hepatocellular carcinoma, but its clinical benefits remain unsatisfactory. During recent years, some studies have reported that the combination of TACE plus thermal ablation can confer a more favourable prognosis than TACE alone. However, clear and compelling evidence to prove the beneficial or harmful effects of the combination of TACE and thermal ablation therapy is lacking.

Objectives: To assess the beneficial and harmful effects of the combination of thermal ablation with TACE versus TACE alone in people with hepatocellular carcinoma.

Search methods: We performed searches in the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials in the Cochrane Library, MEDLINE, Embase, LILACS, Science Citation Index Expanded, and Conference Proceedings Citation Index-Science. We endeavoured to identify relevant randomised clinical trials also in the China National Knowledge Infrastructure (CNKI) and Wanfang databases. We searched trial registration websites for ongoing studies. We also handsearched grey literature sources. The date of last search was 22 December 2020.

Selection criteria: We planned to include all randomised clinical trials comparing the combination of TACE plus thermal ablation versus TACE alone for hepatocellular carcinoma, no matter the language, year of publication, publication status, and reported outcomes.

Data collection and analysis: We planned to use standard methodological procedures expected by Cochrane. We planned to calculate risk ratios (RRs) with the corresponding 95% confidence intervals (CIs). For time-to-event variables, we planned to use the methods of survival analysis and express the intervention effect as a hazard ratio (HR) with 95% Cl. If the log HR and the variance were not directly reported in reports, we planned to calculate them indirectly, following methods for incorporating summary time-to-event data into meta-analysis. We planned to assess the risk of bias of the included studies using the RoB 2 tool. We planned to assess the certainty of evidence with GRADE and present the evidence in a summary of findings table.

Main results: Out of 2224 records retrieved with the searches, we considered 135 records eligible for full-text screening. We excluded 21 of these records because the interventions used were outside the scope of our review or the studies were not randomised clinical trials. We listed the remaining 114 records, reporting on 114 studies, under studies awaiting classification because we could not be sure that these were randomised clinical trials from the information in the study paper. We could not obtain information on the registration of the study protocol for any of the 114 studies. We could not obtain information on study approval by regional research ethics committees, either from the study authors or through our own searches of trial registries. Corresponding authors did not respond to our enquiries about the design and conduct of the studies, except for one from whom we did not receive a satisfactory response. We also raised awareness of our concerns to editors of the journals that published the 114 studies, and we did not hear back with useful information. Moreover, there seemed to be inappropriate inclusion of trial participants, based on cancer stage and severity of liver disease, who should have obtained other interventions according to guidelines from learned societies. Accordingly, we found no confirmed randomised clinical trials evaluating the combination of TACE plus thermal ablation versus TACE alone for people with hepatocellular carcinoma for inclusion in our review. We identified five ongoing trials, by handsearching in clinical trial websites.

Authors' conclusions: We could not find for inclusion any confirmed randomised clinical trials assessing the beneficial or harmful effects of the combination of TACE plus thermal ablation versus TACE alone in people with hepatocellular carcinoma. Therefore, our results did not show or reject the efficiency of the combination of TACE plus thermal ablation versus TACE alone for people with hepatocellular carcinoma. We need trials that compare the beneficial and harmful effects of the combination of TACE plus thermal ablation versus TACE alone in people with hepatocellular carcinoma, not eligible for treatments with curative intent (liver transplantation, ablation surgical resection) and who have sufficient liver reserve, as assessed by the Child Pugh score, and who do not have extrahepatic metastases. Therefore, future trial participants must be classified at Barcelona Clinic Liver Cancer Stage B (intermediate stage) (BCLC-B) or an equivalent, with other staging systems.

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Conflict of interest statement

BZL has no known conflicts of interest. HC has no known conflicts of interest. WL has no known conflicts of interest. ET has no known conflicts of interest.

Figures

1
1
Study flow diagram
Date of last search 22 December 2020
See this image and copyright information in PMC

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  • doi: 10.1002/14651858.CD013345

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References

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He 2016 {published data only}
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Hou 2013 {published data only}
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Huang 2019 {published data only}
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Jiang 2015a {published data only}
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Jiang 2015b {published data only}
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Jiang 2017 {published data only}
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Lai 2019 {published data only}
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Li 2012 {published data only}
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Li 2015 {published data only}
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Li 2016a {published data only}
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    1. Li X, Lv H. The efficacy observation of transcatheter arterial chemoembolization combined with radiofrequency ablation for primary liver cancer [肝动脉化疗栓塞联合射频消融治疗原发性肝癌的疗效观察]. Ji Ceng Yi Xue Lun Tan [Medical Forums in Basic] 2016;20(10):1322-3.
Li 2017a {published data only}
    1. Li J. The clinical effect of the combination of transcatheter arterial chemoembolisation with cryoablation for hepetocellular carcinoma [肝动脉栓塞化疗结合氩氦刀治疗中晚期肝癌的临床疗效]. Dang Dai Yi Xue [Contemporary Medicine] 2017;23:104-6.
Li 2017b {published data only}
    1. Li S. The effect of the combination of transcatheter arterial chemoembolisation with microwave ablation for hepatocellular carcinoma [肝动脉导管化疗栓塞联合CT引导精准微波消融治疗原发性肝癌的效果观察]. Bai Qiu En Yi Xue Za Zhi [Journal of Bethune Military Medical College] 2017;16(6):753-5.
Li 2017c {published data only}
    1. Li X, Zhang H. The quality of patients with hepatocellular carcinoma treated with intervention treatments [放射介入治疗对中晚期肝癌患者生活质量的改善效果]. Shan Xi Yi Xue Za Zhi [Shanxi Medical Journal] 2017;46(9):1237-8.
Li 2018 {published data only}
    1. Li W, Chen J, Zhao S. Improvement of the efficacy of patients with primary hepatic carcinoma by TACE combined with RFA [TACE联合RFA疗法可有效提高原发性肝癌患者的疗效]. Ji Yin Zu Xue Yu Ying Yong Sheng Wu Xue [Genomics and Applied Biology] 2018;37(1):109-14.
Li 2019a {published data only}
    1. Li H. Clinical study of transcatheter arterial chemoembolization combined with radiofrequency ablation in the treatment of hepatocellular carcinoma [肝动脉介入栓塞化疗联合射频消融治疗肝癌的临床效果]. He Ze Yi Xue [Journal of Heze Medical College] 2019;31(1):45-7, 57.
Li 2020 {published data only}
    1. Li X. TACE plus MWA for hepatic cancer and the level of AFP [动脉栓塞化疗联合微波消融治疗肝癌的临床疗效及对血清AFP水平的影响]. Clinical Research 2020;28(10):80-1.
Lin 2017 {published data only}
    1. Lin H. The efficacy of the combination of TACE with radiofrequency ablation for advanced liver cancer [肝动脉栓塞配合射频消融对中晚期肝癌的治疗作用评价]. Te Bie Jian Kang [Special Health] 2017;17:63.
Liu 2016a {published data only}
    1. Liu J. The efficacy and safety of the combinaiton of transcatheter arterial chemoembolisation with microwave ablation for hepatocellular carcinoma [肝动脉化疗栓塞联合微波消融治疗原发性肝癌的临床疗效观察]. Zhong Guo Gao Deng Yi Xue Jiao Yu [China Higher Medical Education] 2016;10:135-6.
Liu 2017 {published data only}
    1. Liu Q, Yu G, Yang G, Zhang Q, Qiu F, Li C, et al. Clinical efficacy and safety of cool-tip microwave ablation combining transcatheter arterial chemoembolization in treatment of patients with primary liver cancer [冷循环微波消融联合肝动脉灌注化疗栓塞治疗原发性肝癌患者疗效及安全性研究]. Shi Yong Gan Zang Bing Za Zhi [Journal of Practical Hepatology] 2017;20(3):316-9.
Liu 2018b {published data only}
    1. Liu D. The effect of the combination of transcatheter arterial chemoembolisation and microwave ablation on serum biomarkers of hepatocellular carcinoma [经动脉导管灌注化疗栓塞术联合微波消融术治疗对肝癌血清标志物的影响]. Gui Zhou Yi Yao [Guizhou Medical Journal] 2018;42(5):567-8.
Liu 2019b {published data only}
    1. Liu L. The analysis on the efficacy of the combination of TACE with CT-guided RFA in patients with primary liver cacner [肝动脉化疗栓塞术联合CT引导下射频消融术对原发性肝癌患者治疗效果分析]. Journal of Imaging Research and Medical Applications 2019;3(14):211-2.
Liu 2019c {published data only}
    1. Liu L. The analysis on the efficacy of TACE plus CT-guided ablation on primary cancer [肝动脉化疗栓塞术联合CT引导下射频消融术对原发性肝癌患者治疗效果分析]. Journal of Imaging Research and Medical Applications 2019;3(14):211-2.
Liu 2019d {published data only}
    1. Liu Q. The comparison on the clinical efficacy between TACE plus MWA and TACE [Tace联合微波消融与单纯tace治疗晚期肝癌的临床疗效对比]. Yiyao Qianyan 2019;9(31):82-3.
Liu 2020 {published data only}
    1. Liu S, Zhong Y, Peng H. The clinical efficacy of the combination of TACE with ultrasound-guided microwave ablation [肝动脉化疗栓塞TACE联合超声引导下微波消融治疗特殊部位肝癌疗效观察]. Guizhou Medical Journal 2020;44(2):212-4.
Lu 2018 {published data only}
    1. Lu C. The clinical effect of the combination of transcatheter arterial chemoembolisation with radiofrequency ablation in hepatocellular carcinoma [经肝动脉化疗栓塞术与经皮穿刺射频消融治疗原发性肝癌的临床效果]. Ji Lin Yi Xue [Jilin Medical Journal] 2018;39(8):1553-4.
Luo 2019 {published data only}
    1. Luo Y, Jiang Y. Comparison of efficiency of TACE plus HIFU and TACE alone on patients with primary liver cancer. Journal of the College of Physicians and Surgeons - Pakistan 2019;29(5):414-7. [PMID: ] - PubMed
Lv 2016 {published data only}
    1. Lv S. The efficacy and safety or transcatheter arterial chemoembolisation plus radiofrequency in hepatocellular carcinma [TACE联合射频消融术治疗原发性肝癌的临床分析]. Lin Chuang Yi Yao Dian Zi Wen Xian Za Zhi [Journal of Clinical Medical Literature] 2016;3(52):10366-7.
Ma 2017 {published data only}
    1. Ma N. Efficacy observation of chemoembolization combined with radio-frequency ablation in the treatment of hepatocellular carcinoma [化疗栓塞术联合射频消融治疗肝癌的疗效观察]. Lin Chuang Yi Xue Yan Jiu Yu Shi Jian [Clinical Research and Practice] 2017;2(34):30-2.
Ma 2019a {published data only}
    1. Ma H. The clinical observation of transcatheter arterial chemoembolisation plus radiofrequency ablation [肝动脉栓塞化疗联合射频消融在原发性肝癌患者中的疗效观察]. Zhong Guo She Qu Yi Shi [Chinese Community Doctors] 2019;35(9):47, 51.
Ma 2019b {published data only}
    1. Ma W. Clinical effect of CT guided precise microwave ablation combined with TACE in the treatment of patients with primary liver cancer [CT引导精准微波消融术联合TACE术治疗原发性肝癌患者的临床效果]. Xian Dai Yi Yong Ying Xiang Xue [Modern Medical Imagelogy] 2019;28(2):272-3.
Ma 2020 {published data only}
    1. Ma Z, Yang L, Wei Q. The effect of ultrasound-guided microwave ablation on the level of TBIL, DBIL, and ALT in patients with intermediate- and advanced-liver cancer [超声引导下微波消融术对中晚期原发性肝癌患者血清TBIL、DBIL、ALT水平的影响及安全性分析]. Modern Medicine and Health Research 2020;4(18):16-8.
Mo 2017 {published data only}
    1. Mo Q, Liu L, Yang X, Duo Y, Yang T. Effect of TACE combined with RFA on serum tumor markers and postoperative survival in patients with primary liver cancer [肝动脉栓塞联合射频消融术治疗对原发性肝癌患者血清肿瘤标志物及术后生存的影响]. Zhong Liu Xue Za Zhi [Journal of Chinese Oncology] 2017;23(12):1142-5.
Pan 2016 {published data only}
    1. Pan W, Huang T, Xie W. The combination of transcatheter arterial chemoembolisation with CT-guided radiofrequency ablation for hepat cellular carcinoma [肝动脉栓塞化疗术联合 CT引导下射频消融治疗肝癌的疗效观察]. Lin Chuang He Li Yong Yao Za Zhi [Chinese Journal of Clinical Rational Drug Use] 2016;9(23):86-7.
Peng 2017 {published data only}
    1. Peng S, Zhu Z, Huang Q. Clinical application of transcatheter arterial chemoembolization combined with microwave ablation in the treatment of primary liver cancer [肝动脉栓塞化疗联合微波消融术治疗原发性肝癌的临床应用]. Lin Chuang Yi Xue Gong Cheng [Clinical Medical and Engineering] 2017;24(7):923-4.
Qu 2014 {published data only}
    1. Qu Z, Wang W, Wan L, Cai Z. The combination of transcatheter arterial chemoembolisation with radiofrequency ablation for 40 patients with hepatocellular carcinoma [肝动脉化疗栓塞联合射频消融治疗原发性肝癌40例分析]. Chong Qing Yi Xue [Chongqing Medicine] 2014;28:3779-81.
Qu 2015 {published data only}
    1. Qu XY, Qin CH, Wu J, Chen ZL, Yang WJ. Transcatheter hepatic arterial chemoembolization in combination with radiofrequency ablation for treatment of patients with hepatocellular carcinoma: curative efficacy and effect on serum BDNF level [化疗栓塞联合射频消融治疗肝癌的疗效及对患者BDNF水平的影响]. Shi Jie Hua Ren Xiao Hua Za Zhi [World Chinese Journal of Digestology] 2015;23(9):1473‐8.
Shen 2015 {published data only}
    1. Shen J, Fu S. The efficacy of the combination of transcatheter arterial chemoembolisation with radiofrequency ablation for primary liver cancer [经导管动脉灌注栓塞化疗联合射频消融治疗原发性肝癌疗效评价]. Yi Xue Li Lun Yu Shi Jian [Journal of Medical Theory and Practice] 2015;20:2781-2.
Shen 2020 {published data only}
    1. Shen Q. Effect of transcatheter arterial chemoembolization combined with percutaneous radiofrequency ablation on postoperative sleep quality in patients with advanced hepatocellular carcinoma [经导管肝动脉化疗栓塞联合经皮射频消融术治疗中晚期肝癌患者术后睡眠质量的影响]. World Journal of Sleep Medicine 2020;7(2):220-1.
Song 2016b {published data only}
    1. Song Z, Li H, Qiang Y. To observe the therapeutic effect of transcatheter arterial chemoembolization combined with microwave ablation in the treatment of primary hepatic carcinoma [观察肝动脉化疗栓塞术联合微波消融治疗原发性大肝癌的疗效]. Zhong Guo Ji Xu Yi Xue Jiao Yu [China Continuing Medical Education] 2016;8(23):100-2.
Song 2018 {published data only}
    1. Song X, Qin P, Teng X, Song R, Dong Z. The clinical efficacy of the combination of transcatheter arterial chemoembolisation with microwave ablation for middle and advanced liver cancer [肝动脉化疗栓塞联合微波消融治疗中晚期肝癌的疗效观察]. Dong Fang Shi Liao Yu Bao Jiang [Oriental Diet Therapy and Health Care] 2018;1:76.
Song 2019 {published data only}
    1. Song B, Jiang H. The feasibility or the combination of transcatheter arterial chemoembolisation with radiofrequency ablation for large hepatocellular carcinoma [肝动脉灌注化疗栓塞术联合射频消融对原发性大肝癌的疗效及可行性研究]. Zhong Guo Xian Dai Yao Wu Ying Yong [Chinese Journal of Modern Drug Application] 2019;13(1):43-4.
Tong 2018 {published data only}
    1. Tong D, Wang H, Jia J, Zhang G, Qiu H, Zhang H. Effect of transcatheter arterial chemoembolization combined with radiofrequency ablation in the treatment of liver cancer [肝动脉化疗栓塞术联合射频消融治疗肝癌疗效观察]. Zhong Guo Ji Ceng Yi Yao [Chinese Journal of Primary Medicine and Pharmacy] 2018;25(1):1-5.
Wang 2013 {published data only}
    1. Wang H, Wang Y, Hou R, Zhang M, Liu C, Xu C. The combination of TACE plus RFA for primary liver cancer [TACE 联合 ＲFA 治疗原发性肝癌的临床疗效]. Shan Dong Yi Yao [Shandong Medical Journal] 2013;53(29):52-4.
Wang 2015a {published data only}
    1. Wang W, Liu W, Duan T, Peng Z. Observation the efficacy of TACE combined with RFA for patients with primary liver cancer [TACE联合RFA治疗原发性肝癌的疗效观察]. Zhong Guo Yi Yao Zhi Nan [Guide of China Medicine] 2015;12:13-5.
Wang 2015b {published data only}
    1. Wang X, Sun J, Xiao B. Efficacy and safety of transcatheter arterial chemoembolization combined with radiofrequency ablation in the treatment of primary liver cancer [肝动脉化疗栓塞联合射频消融治疗原发性肝癌的疗效及安全性]. Zhong Guo Zhong Liu Lin Chuang Yu Kang Fu [Chinese Journal of Clinical Oncology and Rehabilitation] 2015;22(9):1068-70.
Wang 2017a {published data only}
    1. Wang E, Xu J. Effects of transcatheter arterial chemoembolization combined with radio frequency ablation on primary liver cancer [化疗栓塞术结合射频消融术治疗原发性肝癌的效果观察]. Zhong Guo Shi Yong Qi Kan [Chinese Journal of Practical Medicine] 2017;44(3):53-5.
Wang 2017b {published data only}
    1. Wang M, Yin D, Zhu X. The combination of transcatheter arterial chemoembolisation with ultrasound-guided radiofrequency ablation for liver cancer [超声引导下单极冷循环射频消融联合TACE治疗肝癌的效果观察]. Ji Ceng Yi Xue Lun Tan [The Medical Forum] 2017;21(10):1268-9.
Wang 2017c {published data only}
    1. Wang Y, Wang H, You L, Luo D. Clinical observation of transcatheter arterial chemoembolization combined with radio frequency ablation in the treatment of primary liver cancer [肝动脉化疗栓塞联合射频消融治疗原发性肝癌的临床观察]. Shi Yong Yi Yuan Lin Chuang Za Zhi [Practical Journal of Clinical Medicine] 2017;14(4):192-4.
Wang 2017d {published data only}
    1. Wang Z. The combination of transcatheter arterial chemoembolisation with radiofrequency ablation for huge liver cancer [多极射频消融联合 TACE 治疗巨块型肝癌的效果观察]. Lin Chuang He Li Yong Yao Za Zhi [Clinical Research] 2017;10(1):125-6.
Wang 2018a {published data only}
    1. Wang H, Chen H, Song T. Effect of radiofrequency ablation combined with transcatheter arterial chemoembolization on gene expression and survival of primary hepatocellular carcinoma [射频消融联合肝动脉化疗栓塞对原发性肝癌基因表达及生存期的影响]. Xian Dai Zhong Liu Yi Xue [Journal of Modern Oncology] 2018;26(22):3597-601.
Wang 2018b {published data only}
    1. Wang H, Chen H, Song T. The clinical efficacy of the combination of transcatheter arterial chemoembolisation with radiofrequency ablation for liver cancer [TACE联合射频消融术治疗巨块型肝癌临床疗效分析]. Hu Bei Ke Ji Xue Yuan Xue Bao [Journal of Hubei University of Science and Technology] 2018;32(5):390-3.
Wang 2018c {published data only}
    1. Wang J, Liu T, Li X. Efficacy of transcatheter arterial chemoembolization combined with ultrasound-guided radiofrequency ablation for primary carcinoma of liver [经肝动脉栓塞化疗联合超声引导下射频消融治疗原发性肝癌的效果]. Zhong Guo Shi Yong Yi Yao [China Practical Medical] 2018;13(30):22-3.
Wen 2018 {published data only}
    1. Wen P, Lin Z. Efficacy and safety of transcatheter arterial chemoembolization combined with cryoablation in the treatment of unresectable large hepatocellular carcinoma [经导管动脉化疗栓塞术联合冷冻消融治疗不可切除性大肝癌效果与安全性分析]. Zhong Guo Zong He Lin Chuang [Clinical Medicine of China] 2018;34(4):339-43.
Wu 2011b {published data only}
    1. Wu L, Li Z. The combination of cryoablation with transcatheter arterial chemoembolisation for unresectable liver cancer [氩氦刀冷冻与TACE协同治疗无手术指证肝癌的临床分析]. Zhong Wai Jian Kang Wen Zhai [World Health Digest] 2011;8(40):128-9.
Wu 2017b {published data only}
    1. Wu X, Cai B, Wang D. Observation on curative effect of TACE combined with cool-tip microwave ablation in treatment of primary liver cancer [TACE联合冷循环微波消融治疗原发性肝癌的疗效观察]. Zhong Guo Yi Yao Ke Xue [China Medicine and Pharmacy] 2017;7(9):214-6.
Wu 2020 {published data only}
    1. Wu J, Dong G, Liu T. Microwave ablation plus TACE for treating primary liver cancer [冷循环微波消融联合TACE术治疗原发性肝癌的临床研究]. Chinese Hepatology 2020;25(10):1058-61.
Xie 2017 {published data only}
    1. Xie H, Zhong W. Effect of TACE combined with HIFU on elderly patients with primary liver cancer and its effect on immune function [TACE联合HIFU治疗老年原发性肝癌疗效及对患者免疫功能的影响]. He Bei Yi Xue [Hebei Medicine] 2017;23(11):1761-4.
Xiong 2013 {published data only}
    1. Xiong J, Fan G, Chen L. Therapeutic effect of transarterial chemo-embolization combined with radio frequency ablation for treatment of middle or advanced stage hepatocellular carcinoma in elderly [肝动脉化疗栓塞联合经皮射频治疗中晚期老年肝癌的临床观察.]. Zhong Guo Xian Dai Pu Tong Wai Ke Jin Zhan [Chinese Journal of Current Advances in General Surgery] 2013;16(5):355-8.
Xiong 2017 {published data only}
    1. Xiong L, Zhang L, Ma J, Li J. Efficacy of radiofrequency ablation plus hepatic arterial chemoembolization in primary hepatic carcinoma and its effect on serum markers. International Journal Of Clinical And Experimental Medicine 2017;10(9):14076-82.
Xu 2016 {published data only}
    1. Xu L, Li C, Zhang B. The combination of transcatheter arterial chemoembolisation with radiofrequency ablation for progressive liver cancer [超声引导下射频消融联合TACE治疗进展期原发性肝癌疗效及并发症分析]. Gui Zhou Yi Yao [Guizhou Medical Journal] 2016;40(3):265-7.
Xue 2019 {published data only}
    1. Xue J, Chen L, Liao L. The observation on the efficacy of the combination of TACE with MWA [肝动脉栓塞化疗联合冷循环微波消融治疗肝癌的临床疗效观察]. Chinese Journal of Physical Medicine and Rehabilitation 2019;41(6):458-60.
Yao 2018 {published data only}
    1. Yao Y. The efficacy of transcatheter arterial chemoembolisation plus radiofrequency ablation for liver cancer [肝动脉化疗栓塞术联合CT引导下射频消融术对原发性肝癌患者治疗效果]. Man Xing Bing Xue Za Zhi [Chronic Pathematology Journal] 2018;19(4):503-5.
Yi 2015 {published data only}
    1. Yi Y, Lv J, Wang B. The short and long term clinical effect of TACE combined with RFA for patients with primary liver cancer [TACE与RFA联合治疗原发性肝癌患者近远期疗效观察]. Zhong Guo Xian Dai Yi Sheng [China Modern Doctor] 2015;53(24):76-9.
Yu 2019 {published data only}
    1. Yu H. Clinical effect of trans-catheter arterial chemoembolization combined With ultrasound-guided radiofrequency ablation in the treatment of large hepatocellular carcinoma with lack of blood supply [肝动脉化疗栓塞联合超声引导下射频消融治疗乏血供大肝癌的临床效果]. Zhong Guo Dang Dai Yi Yao [China Modern Medicine] 2019;26(5):92-4.
Yuan 2015 {published data only}
    1. Yuan X. The combination or microwave ablation with transcatheter arterial chemoembolisation for hepatocellular carcinoma [微波消融联合血管介入治疗原发性肝癌临床研究]. Zhong Guo Yi Xue Gong Cheng [China Medical Engineering] 2015;23(12):63.
Zhang 2013 {published data only}
    1. Zhang SJ, Ma YL. TACE combined with percutaneous microwave ablation in treatment of large primary hepatocellular carcinoma [经导管动脉化疗栓塞术联合经皮微波消融治疗大肝癌]. Zhong Guo Jie Ru Ying Xiang Yu Zhi Liao Xue [Chinese Journal of Interventional Imaging and Therapy] 2013;10(7):397-400.
Zhang 2014 {published data only}
    1. Zhang S. Clinical effect of primary liver cancer treatment by transcatheter arterial chemoembolization combined radio frequency ablation [肝动脉栓塞化疗联合射频消融治疗原发性肝癌的临床观察]. Zhong Guo Zhong Liu Lin Chuang Yu Jian Kang [Chinese Journal of Clinical Oncology and Rehabilitation] 2014;21(5):576-8.
Zhang 2016 {published data only}
    1. Zhang Z. The combination of cryoablation with transcatheter arterial chemoembolisation for unresectable liver cancer [肝动脉化疗栓塞联合氩氦刀冷冻消融治疗对不能手术的中晚期肝癌疗效的临床分析]. Zhong Guo Xian Dai Yao Wu Fan Ying [Chinese Journal of Modern Drug Application] 2016;10(10):41-2.
Zhang 2017a {published data only}
    1. Zhang H, Ma X, Fu Q, Cao C, Cao L. The efficacy and safety of the combination of microwave ablation with transcatheter arterial chemoembolisation for middle and advanced hepatocellular carcinoma [经肝动脉化疗栓塞联合经皮微波消融序贯治疗中晚期肝癌的疗效及预后分析]. Gan Zang [Chinese Hepatology] 2017;22(5):431-4.
Zhang 2017b {published data only}
    1. Zhang W, Chen G, Sun M, An Y, Wang Y, Shang Q. Clinical efficacy of TACE and radiofrequency ablation in treatment of patients with primary liver cancer [经导管肝动脉化疗栓塞联合射频消融治疗原发性肝癌患者临床疗效评价]. Shi Yong Gan Zang Bing Za Zhi [Journal of Practical Hepatology] 2017;20(4):472-6.
Zhang 2017c {published data only}
    1. Zhang Y. Observation of the efficacy of the combination of microwave ablation and transcatheter arterial chemoembolisation for liver cancer [肝动脉化疗栓塞联合微波消融治疗肝癌的临床疗效探讨]. Xin Li Yi Sheng [Psychological Doctor] 2017;23(19):191-2.
Zhang 2018a {published data only}
    1. Zhang H, Zheng W, Ren N. Observation and nursing of effect of hepatic arterial chemoembolization combined with radiofrequency ablation in treatment of large primary hepatic carcinoma [肝动脉化疗栓塞联合射频消融术治疗原发性大肝癌的效果观察与护理]. Hu Li Shi Jian Yu Yan Jiu [Nursing Practice and Research] 2017;14(16):81-3.
Zhang 2018b {published data only}
    1. Zhang J. The efficacy and safety of the combination of the transcatheter arterial chemoembolisation with radiofrequency ablation for liver cancer [肝动脉化疗栓塞联合射频消融治疗原发性肝癌的疗效及安全性评价]. Lin Chuang Yi Yao Dian Zi Wen Xian Za Zhi [Journal of Clinical Medical Literature] 2018;5(3):54-5.
Zhang 2018c {published data only}
    1. Zhang Q, Zhang Z, Zhang W, Du X. Effect of radiofrequency ablation combined with transcatheter arterial chemoembolization on primary hepatocellular carcinoma and serum cytokines [射频消融联合肝动脉化疗栓塞对原发性肝癌的疗效及对细胞因子的影响]. Shan Xi Yi Yao Za Zhi [Shanxi Medical Journal] 2018;47(11):1244-7.
Zhang 2018d {published data only}
    1. Zhang J, Gao Z, Qian Y, Zhang M, Tan G, Liu Z. Ultrasound-guided microwave ablation plus transcatheter arterial chemoembolisation for primary liver cancer [超声引导下微波消融联合TACE治疗进展期原发性肝癌的疗效分析]. Zhong Guo Yi Yao Zhi Nan [Guide of China Medicine] 2018;16(4):119-20.
Zhang 2019 {published data only}
    1. Zhang G. The transcatheter arterial chemoembolisation plus radiofrequent ablation for hepatocellular carcinoma [肝动脉化疗栓塞术联合射频消融术治疗原发性肝癌]. Zhong Guo Lao Nian Xue Za Zhi [Chinese Journal of Gerontology] 2019;39(8):1855-7.
Zhang 2020 {published data only}
    1. Zhang F, Zhou H. The efficacy of the combination of TACE with MWA for primary liver cancer [肝动脉化疗栓塞联合微波消融治疗原发性肝癌的临床效果]. Henan Medical Research 2020;29(19):3524-5.
Zhao 2014b {published data only}
    1. Zhao Z, Wang R, Zhao F, Li J, Guo S. The transcatheter arterial chemoembolisation plus radiofrequency ablation for 40 patients with hepatocellular carcinoma [肝动脉栓塞联合射频消融治疗肝癌40例疗效评价]. Shan Xi Yi Xue Za Zhi [Shaanxi Medical Journal] 2015;4:587-8.
Zhao 2015a {published data only}
    1. Zhao H, Cui H. The efficacy of the combination of TACE with RFA for primary liver cancer [原发性肝癌 TACE与 RFA 联合治疗临床效果评价]. Da Jia Jian Kang [For All Health] 2015;24:119.
Zhao 2016 {published data only}
    1. Zhao Y, Jia B. Clinical application of hepatic arterial chemoembolization combined with CT guided radiofrequency ablation in the treatment of primary hepatic carcinoma [肝动脉栓塞化疗联合CT引导射频消融治疗原发性肝癌的临床应用]. Yi Xue Ying Xiang Xue Za Zhi [Journal of Medical Imaging] 2016;26(2):364-7.
Zhao 2018 {published data only}
    1. Zhao X. The efficacy of the combination of transcatheter arterial chemoembolisation with microwave ablation for large primary liver cancer [肝动脉化疗栓塞术联合微波消融治疗原发性大肝癌的临床疗效探究]. Te Bie Jian Kang [Special Health] 2018;19:64.
Zhao 2020 {published data only}
    1. Zhao C, Ji L. The effect of the combination of TACE and microwave ablation on the level of AFP and tumour progression [微波消融联合经肝动脉化疗栓塞术治疗肝癌的效果及对血清AFP水平的影响]. Journal of Medical Theory and Practice 2020;33(9):1454-5.
Zheng 2015 {published data only}
    1. Zheng Z. The transcatheter arterial chemoembolisation plus cryoablation for middle and advanced liver cancer [肝动脉化疗栓塞联合氩氦刀冷冻消融治疗中晚期肝癌患者的疗效观察]. Xian Dai Zhen Duan Yu Zhi Liao [Modern Diagnosis and Treatment] 2015;20:4728-9.
Zhu 2013b {published data only}
    1. Zhu L. The transcatheter arterial chemoembolisation plus microwave ablation for 36 patients with hepatocellular carcinoma [肝动脉栓塞化疗联合微波消融治疗中晚期肝癌36例]. Lin Chuang Yi Xue [Clinical Medicine] 2013;33(8):50-1.
Zhu 2015 {published data only}
    1. Zhu H, Chen P. Therapeutic effect of transcatheter arterial chemoembolization combined with radiofrequency ablation for primary liver cancer [经肝动脉化疗栓塞术联合射频消融对原发性肝癌的治疗效果]. Zhong Guo Ji Xu Yi Xue Jiao Yu [China Continuing Medical Education] 2015;7(33):124-6.
Zhuang 2016 {published data only}
    1. Zhuang W, Huang C, Ji Z, Lin S, Huang Y, Tang Y, et al. Analysis of therapeutic effectiveness of argon-helium cryoablation combined with transcatheter arterial chemoembolization for the treatment of advanced hepatocellular carcinoma [TACE 联合氩氦刀冷冻消融治疗中晚期肝癌的疗效分析]. Yi Xue Ying Xiang Za Zhi [Journal of Medical Imaging] 2016;26(12):2247-50. - PubMed

References to ongoing studies

ChiCTR‐IOR‐16007915 {unpublished data only}
    1. ChiCTR-IOR-16007915. Transarterial chemoembolization (TACE) with or without sequential cryoablation in hepatocellular carcinoma of BCLC B: a multicentral randomized controlled trial [Transarterial chemoembolization (TACE) with or without sequential cryoablation in hepatocellular carcinoma of BCLC B: a multicentral randomized controlled trial]. chictr.org.cn/showproj.aspx?proj=13377 (first received 13 February 2016).
ChiCTR‐IOR‐17013743 {unpublished data only}
    1. ChiCTR-IOR-17013743. Treatment of BCLC medium-term hepatocellular carcinoma (HCC) of randomized controlled study of conventional TACE sequential microwave ablation (MWA) and conventional TACE alone [Treatment of BCLC medium-term hepatocellular carcinoma (HCC) of randomized controlled study of conventional TACE sequential microwave ablation (MWA) and conventional TACE alone]. chictr.org.cn/showproj.aspx?proj=23656 (first received 6 December 2017).
NCT02301091 {unpublished data only}
    1. NCT02301091. Combine TACE and RFA versus TACE alone for HCC with PVTT (CORTT) [Combine transcatheter arterial embolization and radiofrequency ablation versus transcatheter arterial embolization alone for hepatocellular carcinoma with portal vein tumor thrombus]. clinicaltrials.gov/ct2/show/NCT02301091 (first received 25 November 2014).
NCT02435953 {unpublished data only}
    1. NCT02435953. TACE + RFA versus TACE alone for intermediate-stage hepatocellular carcinoma [Transarterial chemoembolization plus radiofrequency ablation versus transarterial chemoembolization alone for intermediate-stage hepatocellular carcinoma]. clinicaltrials.gov/ct2/show/NCT02435953 (first received 6 May 2015).
NCT02646137 {unpublished data only}
    1. NCT02646137. Single session combined locoregional therapies for hepatocellular carcinoma [Comparison of single session transarterial chemoembolization combined with microwave ablation or radiofrequency ablation in treatment of hepatocellular carcinoma: a randomized controlled study]. clinicaltrials.gov/ct2/show/NCT02646137 (first received 5 January 2016).

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References to other published versions of this review

Liu 2019a
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