Skip to main content
Top
Published in: Digestive Diseases and Sciences 7/2013

01-07-2013 | Original Article

Combination of Radiofrequency Ablation with Transarterial Chemoembolization for Hepatocellular Carcinoma: A Meta-Analysis

Authors: Shushan Yan, Donghua Xu, Beicheng Sun

Published in: Digestive Diseases and Sciences | Issue 7/2013

Login to get access

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 (OR1-year = 2.06, 95 % CI 1.46–2.91, P < 0.001; OR3-year = 1.93, 95 % CI 1.18–3.15, P = 0.009; OR5-year = 1.87, 95 % CI 1.23–2.83, P = 0.003). The overall quality of the 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 sizes are needed to provide sufficient evidence.
Literature
1.
2.
go back to reference Guimaraes M, Uflacker R. Locoregional therapy for hepatocellular carcinoma. Clin Liver Dis. 2011;15:395–421.PubMedCrossRef Guimaraes M, Uflacker R. Locoregional therapy for hepatocellular carcinoma. Clin Liver Dis. 2011;15:395–421.PubMedCrossRef
3.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
4.
go back to reference 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. 2011;81:e189–e193 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. 2011;81:e189–e193
5.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
6.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
7.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
8.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
9.
go back to reference Atkins D, Best D, Briss PA, et al. Grading quality of evidence, strength of recommendations. BMJ. 2004;328:1490.PubMedCrossRef Atkins D, Best D, Briss PA, et al. Grading quality of evidence, strength of recommendations. BMJ. 2004;328:1490.PubMedCrossRef
10.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
11.
go back to reference Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22:719–748.PubMed Mantel N, Haenszel W. Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst. 1959;22:719–748.PubMed
12.
13.
go back to reference Cochran WG. The combination of estimates from different experiments. Biometrics. 1954;10:101–129.CrossRef Cochran WG. The combination of estimates from different experiments. Biometrics. 1954;10:101–129.CrossRef
14.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
15.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
16.
go back to reference Aikata H, Shirakawa H, Takaki S. Radiofrequency ablation combined with transcatheter arterial chemoembolization for small hepatocellular carcinoma. Hepatology. 2006;44:A487.CrossRef Aikata H, Shirakawa H, Takaki S. Radiofrequency ablation combined with transcatheter arterial chemoembolization for small hepatocellular carcinoma. Hepatology. 2006;44:A487.CrossRef
17.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
18.
go back to reference 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.PubMed 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.PubMed
19.
go back to reference 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. 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.
20.
go back to reference 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. (in Chinese).PubMed 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. (in Chinese).PubMed
21.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
22.
go back to reference 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. (in Chinese).PubMed 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. (in Chinese).PubMed
23.
go back to reference 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. (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. (in Chinese).
24.
go back to reference 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. (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. (in Chinese).
25.
go back to reference 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. (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. (in Chinese).
26.
go back to reference 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. (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. (in Chinese).
27.
go back to reference 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. (in Chinese).PubMed 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. (in Chinese).PubMed
28.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
29.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
30.
go back to reference Hu YQ. Radiofrequency ablation and transcatheter arterial chemoembolization in primary hepatic carcinoma. Contemp Med. 2011;17:232–233. (in Chinese). Hu YQ. Radiofrequency ablation and transcatheter arterial chemoembolization in primary hepatic carcinoma. Contemp Med. 2011;17:232–233. (in Chinese).
31.
go back to reference Yang JD, Roberts LR. Hepatocellular carcinoma: a global view. Nat Rev Gastroenterol Hepatol. 2010;7:448–458.PubMedCrossRef Yang JD, Roberts LR. Hepatocellular carcinoma: a global view. Nat Rev Gastroenterol Hepatol. 2010;7:448–458.PubMedCrossRef
32.
go back to reference Jarnagin W, Chapman WC, Curley S, et al. Surgical treatment of hepatocellular carcinoma: expert consensus statement. HPB (Oxf). 2010;12:302–310. Jarnagin W, Chapman WC, Curley S, et al. Surgical treatment of hepatocellular carcinoma: expert consensus statement. HPB (Oxf). 2010;12:302–310.
33.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
34.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
35.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
Metadata
Title
Combination of Radiofrequency Ablation with Transarterial Chemoembolization for Hepatocellular Carcinoma: A Meta-Analysis
Authors
Shushan Yan
Donghua Xu
Beicheng Sun
Publication date
01-07-2013
Publisher
Springer US
Published in
Digestive Diseases and Sciences / Issue 7/2013
Print ISSN: 0163-2116
Electronic ISSN: 1573-2568
DOI
https://doi.org/10.1007/s10620-013-2570-8

Other articles of this Issue 7/2013

Digestive Diseases and Sciences 7/2013 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.