What is the best combination treatment with transarterial chemoembolization of unresectable hepatocellular carcinoma? a systematic review and network meta-analysis

Hui Xie, Haipeng Yu, Shengtao Tian, Xueling Yang, Ximing Wang, Zhao Yang, Huaming Wang and Zhi Guo _

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Oncotarget. 2017; 8:100508-100523. https://doi.org/10.18632/oncotarget.20119

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Hui Xie1,2, Haipeng Yu1, Shengtao Tian2, Xueling Yang1, Ximing Wang2, Zhao Yang2, Huaming Wang2 and Zhi Guo1

1Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin 300070, China

2Department of Interventional Therapy, 302 Hospital of People's Liberation Army, Beijing 100039, China

Correspondence to:

Zhi Guo, email: [email protected]

Huaming Wang, email: [email protected]

Keywords: transarterial chemoembolization, TACE, unresectable hepatocellular carcinoma, combination treatment, network meta-analysis

Received: July 07, 2017     Accepted: July 30, 2017     Published: August 10, 2017


Objective: To assess the comparative efficacy and safety of combination treatment with transarterial chemoembolization (TACE) for patients with unresectable hepatocellular carcinoma (HCC) through a systematic review and network meta-analysis and to identify what is the best combination treatment with TACE.

Materials and Methods: A network meta-analysis was used to identify evidence from relevant randomized controlled trials. We searched databases for publications up to June 2017. The prespecified primary efficacy outcomes were treatment response and 6-month to 3-year overall survival (OS), while the secondary efficacy outcomes were 1- and 2-year disease-free survival (DFS); safety outcomes were advance effects of combination treatment. We conducted pairwise meta-analyses using a random-effects model and then performed random-effects network meta-analyses.

Results: A total of 48 trials were eligible (50 analyses), involving 5627 patients and 19 treatment arms. In comparison with other types of combination therapy arms, network meta-analysis disclosed that TACE + three-dimensional conformal radiotherapy, TACE + percutaneous ethanol injection, TACE + percutaneous microwave coagulation therapy, TACE + percutaneous acetic acid injection, and TACE + sorafenib were the more effective methods in treatment response, 6-month to 3-year OS, and 1–2 year DFS; the adverse effects of TACE + sorafenib were serious. The study was registered with PROSPERO, number CRD42017071102.

Conclusions: When considering the efficacy, combination therapy with TACE seemed to offer clear advantages for patients with unresectable HCC. TACE + Three-dimensional conformal radiotherapy, TACE + Percutaneous ethanol injection, TACE + Percutaneous microwave coagulation therapy, and TACE + Percutaneous acetic acid injection are likely the best options to consider in the application of combination treatment.

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