Radiofrequency ablation plus chemoembolization versus radiofrequency ablation alone for hepatocellular carcinoma: a meta-analysis of randomized-controlled trials.

BACKGROUND: There is a continuing debate on whether transcatheter arterial chemoembolization (TACE) plus radiofrequency ablation (RFA) is more effective than RFA alone in the treatment of patients with hepatocellular carcinoma (HCC). We carried out this meta-analysis of randomized-controlled trials to provide greater clarity on whether RFA plus TACE was more effective than RFA alone for HCC.

METHODS: A literature search was carried out for all possible randomized-controlled trials. The outcomes were overall survival rates and major complications. Data were abstracted using standardized forms, and an overall rating of the quality of evidence was assigned using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria. We estimated summary odds ratio (OR) with its 95% confidence interval (95% CI) to assess the effects.

RESULTS: Seven randomized-controlled trials were included. Meta-analysis showed that RFA plus TACE significantly improved the survival rates of patients with HCC at 1 and 3 years (for the one-survival rate, fixed-effects OR=2.71, 95% CI 1.65-4.43, P<0.0001; for the three-survival rate, fixed-effects OR=2.27, 95% CI 1.57-3.27, P<0.0001) compared with RFA alone. There was no difference in terms of major complications (fixed-effects OR=1.26, 95% CI 0.33-4.77, P=0.73). Subgroup analyses by tumor size showed that RFA plus TACE significantly improved the survival rates at 1, 3, and 5 years compared with RFA alone in patients with HCC larger than 3 cm; however, there was no advantage of TACE plus RFA over RFA alone for patients with HCC smaller than 3 cm. The quality of evidence was high for the 1-year survival rate, the 3-year survival rate, and major complications. No evidence of publication bias was observed.

CONCLUSION: High-quality evidence suggests that TACE plus RFA improve the survival rates compared with RFA alone for patients with HCC larger than 3 cm.