Radiofrequency ablation with or without transarterial chemoembolization for hepatocellular carcinoma: A systematic review and meta-analysis

AIM: To determine whether combined transarterial chemoembolization(TACE) and radiofrequency ablation(RFA) improve overall and recurrence-free survival(RFS) compared with RFA alone. METHODS: We reviewed randomized clinical trials(RCTs) comparing overall survival rate as well as recurrence-free rate for hepatocellular carcinoma(HCC) between TACERFA therapy and RFA alone published before April 2015 by conducting a systematic review and meta-analysis. Eligible studies were identified by searching Pub Med and EMBASE up to April 2015. Additional studies were retrieved via China Medical Collections, Google Scholar or a hand review of the reference lists of the retrieved articles. The summarized relative risks(RRs) with their 95%CIs were estimated using random-effects model. I2 statistic was calculated to measure the heterogeneity of RRs across studies and Cochran’s Q test was used to test the statistical significance accordingly. Publication bias was assessed primarily based on visual assessment using a funnel plot, and secondly by using Egger’s regression asymmetry test or Begg’s rank correlation test as appropriate. Meta-regression was implemented to examine potential effect modifiers. RESULTS: Nine single-center RCTs conducted in China and Japan were included, with a total of 618 patients with HCC; 321 of whom(51.9%) received TACE/RFA therapy and 297 received RFA alone. The pooled RRs with corresponding CIs comparing combined TACE/RFA to RFA alone were 1.12(1.004-1.26) and 1.20(1.02-1.41) for 1-year and 3-year survival rates, respectively. Similar positive associations were found for 1-year(1.19; 1.05-1.35) and 3-year(1.44; 1.00-2.07) RFS. Thebeneficial effect was more evident in patients with medium-sized(3-5 cm) tumors and among the Chinese population. CONCLUSION: Combined TACE/RFA has a beneficial effect on survival and recurrence rates compared with RFA alone, especially for medium-sized HCC and among Chinese patients.