Efficacy of transcatheter arterial chemoembolization in patients with hepatocellular carcinoma before hepatectomy:a meta-analysis

Objective To assess the efficacy of transcatheter arterial chemoembolization ( TACE) in patients with hepatocellular carcinoma ( HCC) before hepatectomy. Methods PubMed, Embase, the Cochrane Library, CNKI, VIP, and Wanfang Data were searched to identify randomized controlled trials ( RCTs) evaluating the efficacy of preoperative TACE plus hepatectomy ( study group) versus hepatectomy alone ( control group) in HCC patients published up to March 12, 2013. The quality of included studies was assessed, and relevant data were extracted. Statistical analysis was performed by RevMan 5. 2. Results A total of 4 RCTs involving 342 participants were included. Meta- analysis of data extracted from the included RCTs showed that there were no significant differences between the study group and control group in 1-, 3-, and 5- year disease- free survival ( DFS) , with relative risks ( RRs) ( 95% confidence intervals ( CIs) ) of 1. 07 ( 0. 92-1. 25) ( P = 0. 38) , 1. 05 ( 0. 79, 1. 41) ( P = 0. 72) , and 0. 95 ( 0. 64- 1. 42) ( P = 0. 81) , respectively, in 1-, 3-, and 5- year overall survival ( OS) , with RRs ( 95% CIs) of 1. 01 ( 0. 92- 1. 10) ( P = 0. 85) , 1. 14 ( 0. 97- 1. 34) ( P = 0. 11) , and 0. 95 ( 0. 75-1. 21) ( P = 0. 68) , respectively, and in rate of postoperative complications and mortality, with RRs ( 95% CIs) of 0. 89 ( 0. 45- 1. 75) ( P= 0. 73) and 0. 77 ( 0. 25- 2. 37) ( P = 0. 65) , respectively. Conclusion TACE before hepatectomy cannot increase DFS and OS and reduce complications and mortality in HCC patients. However, the numbers of studies and cases included in the analysis are small, and more high- quality, large- sample RCTs are needed to confirm the conclusion.