Limits...
Transarterial chemoembolization versus hepatic resection in hepatocellular carcinoma treatment: a meta-analysis.

Tian X, Dai Y, Wang DQ, Zhang L, Sui CG, Meng FD, Jiang SY, Liu YP, Jiang YH - Drug Des Devel Ther (2015)

Bottom Line: Pooled estimates showed that, compared with TACE, HR significantly improved the 3-year OS (RR =0.77; 95% CI, 0.63-0.93; P=0.009).This meta-analysis suggests that the TACE and HR likely have similar effects in the treatment of HCC patients in terms of OS and recurrence rate.However, this conclusion should be interpreted cautiously due to the presence of further subgroup analyses with respect to outcomes in patients with different liver statuses (Barcelona Clinic Liver Cancer stage A or stage B).

View Article: PubMed Central - PubMed

Affiliation: Molecular Oncology Laboratory of Cancer Research Institute, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.

ABSTRACT

Background: A number of cohort studies have compared the outcomes of transarterial chemoembolization (TACE) and hepatic resection (HR) in the treatment of hepatocellular carcinoma (HCC). However, the effect of TACE versus HR remains controversial. Therefore, we conducted a meta-analysis to assess the effectiveness of TACE and HR in HCC treatment.

Materials and methods: PubMed, Embase, Web of Science, Scopus, ClinicalTrials.gov, and Cochrane library were searched from their inception until February 27, 2015 for relevant studies. The literature search was updated on May 25, 2015. Eligible studies were cohort studies comparing the survival outcomes between HCC patients undergoing TACE and HR. The primary outcome was overall survival (OS). Secondary outcomes were the recurrence rate and prognostic factors for OS. The risk ratio (RR) was used for the meta-analysis and was expressed with 95% confidence intervals (CIs).

Results: This meta-analysis included eleven cohort studies with 6,297 patients, all treated with TACE or HR. Pooled estimates showed that, compared with TACE, HR significantly improved the 3-year OS (RR =0.77; 95% CI, 0.63-0.93; P=0.009). TACE and HR had similar effects on OS after 1 year (RR =0.94; 95% CI, 0.86-1.01; P=0.103), 2 years (RR =0.50; 95% CI, 0.21-1.19; P=0.114), 4 years (RR =0.61; 95% CI, 0.58-1.10; P=0.174), and 5 years (RR =0.77; 95% CI, 0.59-1.01; P=0.06). There was no significant difference between the 3-year (RR =1.31; 95% CI, 0.65-2.64; P=0.457) and 5-year recurrence rates (RR =1.14; 95% CI, 0.69-1.89; P=0.597) in the TACE and HR groups. Age (>65 vs ≤65 years; hazard ratio =0.99; 95% CI, 0.98-1.00; P=0.000), sex (male vs female; hazard ratio =0.79; 95% CI, 0.65-0.96; P=0.02), treatment method (TACE vs HR; hazard ratio =1.90; 95% CI, 1.46-2.46; P=0.000), and Eastern Cooperative Oncology Group performance score (≥1 vs 0; hazard ratio =1.69; 95% CI, 1.22-2.33; P=0.002) were independent predictors for OS.

Conclusion: This meta-analysis suggests that the TACE and HR likely have similar effects in the treatment of HCC patients in terms of OS and recurrence rate. However, this conclusion should be interpreted cautiously due to the presence of further subgroup analyses with respect to outcomes in patients with different liver statuses (Barcelona Clinic Liver Cancer stage A or stage B).

No MeSH data available.


Related in: MedlinePlus

TACE versus HR for HCC in terms of 4-year overall survival rate.Notes: Boxes are the relative risk estimates from each study; the horizontal bars are 95% CIs. The size of the box is proportional to the weight of the study in the pooled analysis. Weights are from random effects analysis.Abbreviations: TACE, transarterial chemoembolization; HR, hepatic resection; HCC, hepatocellular carcinoma; CI, confidence interval; RR, risk ratio.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4539084&req=5

f5-dddt-9-4431: TACE versus HR for HCC in terms of 4-year overall survival rate.Notes: Boxes are the relative risk estimates from each study; the horizontal bars are 95% CIs. The size of the box is proportional to the weight of the study in the pooled analysis. Weights are from random effects analysis.Abbreviations: TACE, transarterial chemoembolization; HR, hepatic resection; HCC, hepatocellular carcinoma; CI, confidence interval; RR, risk ratio.

Mentions: Among the eleven studies included in this meta-analysis, only three studies reported the data of 4-year survival rates.27,29,32 Of them, two studies29,32 showed that the 4-year survival rate was similar between the two groups. The remaining study27 demonstrated that the 4-year survival rate was significantly higher in the HR group than in the TACE group. Using a random-effects model, the pooled estimates revealed that the patients in the TACE group did not have a higher 4-year survival rate than those in the HR group (RR =0.61; 95% CI, 0.34–1.10; P=0.174) (Figure 5). As the number of eligible studies for meta-analysis was less than five, publication bias was not assessed.


Transarterial chemoembolization versus hepatic resection in hepatocellular carcinoma treatment: a meta-analysis.

Tian X, Dai Y, Wang DQ, Zhang L, Sui CG, Meng FD, Jiang SY, Liu YP, Jiang YH - Drug Des Devel Ther (2015)

TACE versus HR for HCC in terms of 4-year overall survival rate.Notes: Boxes are the relative risk estimates from each study; the horizontal bars are 95% CIs. The size of the box is proportional to the weight of the study in the pooled analysis. Weights are from random effects analysis.Abbreviations: TACE, transarterial chemoembolization; HR, hepatic resection; HCC, hepatocellular carcinoma; CI, confidence interval; RR, risk ratio.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4539084&req=5

f5-dddt-9-4431: TACE versus HR for HCC in terms of 4-year overall survival rate.Notes: Boxes are the relative risk estimates from each study; the horizontal bars are 95% CIs. The size of the box is proportional to the weight of the study in the pooled analysis. Weights are from random effects analysis.Abbreviations: TACE, transarterial chemoembolization; HR, hepatic resection; HCC, hepatocellular carcinoma; CI, confidence interval; RR, risk ratio.
Mentions: Among the eleven studies included in this meta-analysis, only three studies reported the data of 4-year survival rates.27,29,32 Of them, two studies29,32 showed that the 4-year survival rate was similar between the two groups. The remaining study27 demonstrated that the 4-year survival rate was significantly higher in the HR group than in the TACE group. Using a random-effects model, the pooled estimates revealed that the patients in the TACE group did not have a higher 4-year survival rate than those in the HR group (RR =0.61; 95% CI, 0.34–1.10; P=0.174) (Figure 5). As the number of eligible studies for meta-analysis was less than five, publication bias was not assessed.

Bottom Line: Pooled estimates showed that, compared with TACE, HR significantly improved the 3-year OS (RR =0.77; 95% CI, 0.63-0.93; P=0.009).This meta-analysis suggests that the TACE and HR likely have similar effects in the treatment of HCC patients in terms of OS and recurrence rate.However, this conclusion should be interpreted cautiously due to the presence of further subgroup analyses with respect to outcomes in patients with different liver statuses (Barcelona Clinic Liver Cancer stage A or stage B).

View Article: PubMed Central - PubMed

Affiliation: Molecular Oncology Laboratory of Cancer Research Institute, The First Affiliated Hospital of China Medical University, Shenyang, People's Republic of China.

ABSTRACT

Background: A number of cohort studies have compared the outcomes of transarterial chemoembolization (TACE) and hepatic resection (HR) in the treatment of hepatocellular carcinoma (HCC). However, the effect of TACE versus HR remains controversial. Therefore, we conducted a meta-analysis to assess the effectiveness of TACE and HR in HCC treatment.

Materials and methods: PubMed, Embase, Web of Science, Scopus, ClinicalTrials.gov, and Cochrane library were searched from their inception until February 27, 2015 for relevant studies. The literature search was updated on May 25, 2015. Eligible studies were cohort studies comparing the survival outcomes between HCC patients undergoing TACE and HR. The primary outcome was overall survival (OS). Secondary outcomes were the recurrence rate and prognostic factors for OS. The risk ratio (RR) was used for the meta-analysis and was expressed with 95% confidence intervals (CIs).

Results: This meta-analysis included eleven cohort studies with 6,297 patients, all treated with TACE or HR. Pooled estimates showed that, compared with TACE, HR significantly improved the 3-year OS (RR =0.77; 95% CI, 0.63-0.93; P=0.009). TACE and HR had similar effects on OS after 1 year (RR =0.94; 95% CI, 0.86-1.01; P=0.103), 2 years (RR =0.50; 95% CI, 0.21-1.19; P=0.114), 4 years (RR =0.61; 95% CI, 0.58-1.10; P=0.174), and 5 years (RR =0.77; 95% CI, 0.59-1.01; P=0.06). There was no significant difference between the 3-year (RR =1.31; 95% CI, 0.65-2.64; P=0.457) and 5-year recurrence rates (RR =1.14; 95% CI, 0.69-1.89; P=0.597) in the TACE and HR groups. Age (>65 vs ≤65 years; hazard ratio =0.99; 95% CI, 0.98-1.00; P=0.000), sex (male vs female; hazard ratio =0.79; 95% CI, 0.65-0.96; P=0.02), treatment method (TACE vs HR; hazard ratio =1.90; 95% CI, 1.46-2.46; P=0.000), and Eastern Cooperative Oncology Group performance score (≥1 vs 0; hazard ratio =1.69; 95% CI, 1.22-2.33; P=0.002) were independent predictors for OS.

Conclusion: This meta-analysis suggests that the TACE and HR likely have similar effects in the treatment of HCC patients in terms of OS and recurrence rate. However, this conclusion should be interpreted cautiously due to the presence of further subgroup analyses with respect to outcomes in patients with different liver statuses (Barcelona Clinic Liver Cancer stage A or stage B).

No MeSH data available.


Related in: MedlinePlus