Abstract
Background
Recent studies suggest that the combination of radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) may have a synergistic effect for hepatocellular carcinoma (HCC).
Aims
The aim of this meta-analysis was to compare the effectiveness of combination of RFA and TACE with that of RFA alone in patients with HCC.
Methods
Randomized controlled trials and retrospective cohort studies comparing RFA plus TACE with RFA alone for HCC were included into this meta-analysis. Study quality was rated with a standardized scale and the strength of evidence was also rated by using the grading of recommendations assessment, development, and evaluation system (GRADE system).
Results
Meta-analyses showed that the combination of RFA and TACE was obviously associated with higher survival rates (odds ratio [OR]1-year = 2.14, 95 % confidence interval [95 % CI] 1.57–2.91, P < 0.001; OR3-year = 1.98, 95 % CI 1.28–3.07, P = 0.001; OR5-year = 2.70, 95 % CI 1.42–5.14, P = 0.003). The overall quality of evidence was judged to be low by using the GRADE system.
Conclusions
The combination of TACE with RFA can improve the overall survival rate and provides better prognosis for patients with HCC, but more randomized controlled trials using large sample size are needed to provide sufficient evidence.
Similar content being viewed by others
References
Lencioni R. Loco-regional treatment of hepatocellular carcinoma. Hepatology. 2010;52:762–773.
Guimaraes M, Uflacker R. Locoregional therapy for hepatocellular carcinoma. Clin Liver Dis. 2011;15:395–421.
Germani G, Pleguezuelo M, Gurusamy K, Meyer T, Isgro G, Burroughs AK. Clinical outcomes of radiofrequency ablation, percutaneous alcohol and acetic acid injection for hepatocelullar carcinoma: a meta-analysis. J Hepatol. 2010;52:380–388.
Kim JW, Kim JH, Won HJ, et al. Hepatocellular carcinomas 2–3 cm in diameter: transarterial chemoembolization plus radiofrequency ablation vs. radiofrequency ablation alone. Eur J Radiol. 2012;81:e189–193.
Kim JH, Won HJ, Shin YM, et al. Medium-sized (3.1–5.0 cm) hepatocellular carcinoma: transarterial chemoembolization plus radiofrequency ablation versus radiofrequency ablation alone. Ann Surg Oncol. 2011;18:1624–1629.
Wang W, Shi J, Xie WF. Transarterial chemoembolization in combination with percutaneous ablation therapy in unresectable hepatocellular carcinoma: a meta-analysis. Liver Int. 2010;30:741–749.
Tiong L, Maddern GJ. Systematic review and meta-analysis of survival and disease recurrence after radiofrequency ablation for hepatocellular carcinoma. Br J Surg. 2011;98:1210–1224.
Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–926.
Atkins D, Best D, Briss PA, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004;328:1490.
Higgins JP, Altman DG, Gotzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.
Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22:719–748.
DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7:177–188.
Cochran WG. The combination of estimates from different experiments. Biometrics. 1954;10:101–129.
Stuck AE, Rubenstein LZ, Wieland D. Bias in meta-analysis detected by a simple, graphical test. Asymmetry detected in funnel plot was probably due to true heterogeneity. BMJ. 1998;316:469.
Shibata T, Isoda H, Hirokawa Y, Arizono S, Shimada K, Togashi K. Small hepatocellular carcinoma: is radiofrequency ablation combined with transcatheter arterial chemoembolization more effective than radiofrequency ablation alone for treatment? Radiology. 2009;252:905–913.
Cheng BQ, Jia CQ, Liu CT, et al. Chemoembolization combined with radiofrequency ablation for patients with hepatocellular carcinoma larger than 3 cm: a randomized controlled trial. JAMA. 2008;299:1669–1677.
Aikata H, Shirakawa H, Takaki S. Radiofrequency ablation combined with transcatheter arterial chemoembolization for small hepatocellular carcinoma. Hepatology. 2006;44:A487.
Morimoto M, Numata K, Kondou M, Nozaki A, Morita S, Tanaka K. Midterm outcomes in patients with intermediate-sized hepatocellular carcinoma: a randomized controlled trial for determining the efficacy of radiofrequency ablation combined with transcatheter arterial chemoembolization. Cancer. 2010;116:5452–5460.
Shen SQ, Xiang JJ, Xiong CL, Wu SM, Zhu SS. Intraoperative radiofrequency thermal ablation combined with portal vein infusion chemotherapy and transarterial chemoembolization for unresectable HCC. Hepatogastroenterology. 2005;52:1403–1407.
Kang CB, Xu HB, Wang SL, Rui B. Treatment of large hepatoma by TACE in combination with RFA. Chin J Hepatobiliary Surg. 2007;13:828–830.
Wang YB, Chen MH, Yan K, Yang W, Dai Y, Yin SS. Quality of life of primary hepatocellular carcinoma patients after radiofrequency ablation. Ai Zheng. 2005;24:827–833 [Article in Chinese].
Yang P, Liang M, Zhang Y, Shen B. Clinical application of a combination therapy of lentinan, multi-electrode RFA and TACE in HCC. Adv Ther. 2008;25:787–794.
Xu L, Li P, Chen MS, et al. Percutaneous radiofrequency ablation combined with other minimally invasive treatments for recurrent hepatocellular carcinoma after hepatectomy. Zhonghua Wai Ke Za Zhi. 2008;46:1617–1620 [Article in Chinese].
Shen L, Chen MH, Yan K, et al. Clinical application of a combination therapy of percutaneous radiofrequency and transcatheter arterial chemoembolization in large hepatic tumors. Zhonghua Chao Sheng Yin Xiang Xue Za Zhi. 2004;13:577–580 [Article in Chinese].
Zhang HC, Liang J. Radiofrequency ablation or transcather arterial chemoembolization for management of hepatocellular carcinoma. Zhong Guo Yi Shi Jin Xiu Za Zhi. 2007;30:67–68 [Article in Chinese].
Liang MH. Transcather arterial chemoembolization combined with radiofrequency ablation for the management of hepatocellular carcinoma. Zhong Guo Lao Nian Yi Xue Za Zhi. 2011;31:2862–2864 [Article in Chinese].
Luo ZG, Xiong K, Duan QW, Ren JM, Wang DW, Li C. Therapy of 3-dimension conformui technology guided radiofrequency ablation and trascatheter arterial chemoembolizatlon in primary hepatic carcinonm. Yunyang Yi Xue Yuan Xue Bao. 2008;27:22–25 [Article in Chinese].
Li ZR, Kang Z, Qian JS, et al. Radiofrequency ablation with or without transcather arterial chemoembolization for management of hepatocellular carcinoma. Nan Fang Yi Ke Da Xue Xue Bao. 2007;27:1749–1751 [Article in Chinese].
Yang W, Chen MH, Wang MQ, et al. Combination therapy of radiofrequency ablation and transarterial chemoembolization in recurrent hepatocellular carcinoma after hepatectomy compared with single treatment. Hepatol Res. 2009;39:231–240.
Peng ZW, Chen MS, Liang HH, et al. A case-control study comparing percutaneous radiofrequency ablation alone or combined with transcatheter arterial chemoembolization for hepatocellular carcinoma. Eur J Surg Oncol. 2010;36:257–263.
Hu YQ. Radiofrequency ablation and transcatheter arterial chemoembolization in primary hepatic carcinoma. Contemp Med. 2011;17:232–233 [Article in Chinese].
Yang JD, Roberts LR. Hepatocellular carcinoma: a global view. Nat Rev Gastroenterol Hepatol. 2010;7:448–458.
Jarnagin W, Chapman WC, Curley S, et al. Surgical treatment of hepatocellular carcinoma: expert consensus statement. HPB (Oxf). 2010;12:302–310.
Cho YK, Kim JK, Kim MY, Rhim H, Han JK. Systematic review of randomized trials for hepatocellular carcinoma treated with percutaneous ablation therapies. Hepatology. 2009;49:453–459.
Wang N, Guan Q, Wang K, et al. TACE combined with PEI versus TACE alone in the treatment of HCC: a meta-analysis. Med Oncol. 2011;28:1038–1043.
Simmonds MC, Higgins JP, Stewart LA, Tierney JF, Clarke MJ, Thompson SG. Meta-analysis of individual patient data from randomized trials: a review of methods used in practice. Clin Trials. 2005;2:209–217.
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Additional information
Shushan Yan and Donghua Xu contributed equally to this work.
Rights and permissions
About this article
Cite this article
Yan, S., Xu, D. & Sun, B. Combination of Radiofrequency Ablation with Transarterial Chemoembolization for Hepatocellular Carcinoma: A Meta-Analysis. Dig Dis Sci 57, 3026–3031 (2012). https://doi.org/10.1007/s10620-012-2212-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-012-2212-6