| Objective: Radical resection surgery is an effective method to improve the survival rate of hepatocellular carcinoma(HCC).However,the recurrence rate of hepatocellular carcinoma is as high as 70%-80% within 5 years after operation.The high recurrence rate was related to microvascular invasion(MVI)during the development of HCC.MVI is considered to be one of the independent risk factors for poor prognosis in patients with HCC.The aim of this study was to analyze the effect of Transcatheter Arterial Chemoembolization(TACE)on the survival outcome of patients of hepatocellular carcinoma with MVI after radical resection surgery.Methods: Retrieving Pub Med,Cochorane Libarary,EMbase Database(Excerpt Medica Database),CNKI,Wangfang Database,Weipu Database,and collect For all clinical studies on the efficacy of TACE in the treatment of hepatocellular carcinoma with microvascular invasion in patients undergoing radical hepatocellular carcinoma resection.from the establishment of the database to 2020.12.Two researchers independently double-blindly read the title,abstract,and full text of the article,and screened the literature based on the inclusion and exclusion criteria.The Newcastle-Ottawa Scale(NOS)and Jadad Evaluation Scale were used to evaluate the quality of the literature for the included literatures that met the established criteria,and low-quality literatures were excluded.After extracting basic information and outcome indicators from the included literature,the Review Manager 5.4 software was used for statistical analysis.Relapse-free survival(RFS)and cumulative survival(OS)are the main outcome indicators,including 1 year,2 years,3 years,and 5 years RFS after surgery,and 1 year and 2 years after surgery,3-year,5-year OS and analysis of risk factors affecting patient survival.The statistical analysis results are quantitatively judged by Q test and I~2,and the random effect model(REM)or fixed effect model(FEM)is selected to calculate the combined statistics.This study uses a funnel chart to evaluate whether there is a publication offset.At the same time,the method of "one-by-one elimination" is used to compare whether there are any substantial changes between the combined effect sizes for sensitivity analysis.RESULTS: A total of 13 literatures(8 literatures in English and 5 literatures in Chinese)were included.1378 cases were included in the HR-TACE group(sequential transcatheter arterial chemoembolization after radical hepatocellular carcinoma resection group);HR group(simple radical hepatocellular carcinoma resection group)had 1636 cases.The results of meta-analysis showed that the RFS of HR-TACE group at1,2,3,and 5 years after radical HCC resection was better than that of the HR group(OR=1.96,95%CI: 1.68-2.29,P<0.00001;2 years after surgery: OR=1.85,95%CI:1.51-2.28,P<0.00001,Sensitivity analysis results: OR=2.08,95%CI: 1.66-2.59,P<0.00001;3 years after surgery: OR=1.95,95%CI: 1.67-2.28,P<0.00001;5 years after surgery: OR=1.45,95%CI: 1.21-1.75,P<0.0001),the difference was statistically significant.Similarly,HR-TACE group had a significant benefit advantage in OS 1,2,3,and 5 years after radical HCC resection compared with HR group(1 year after surgery:OR=2.53,95%CI: 1.50-4.28,P=0.0005,sensitivity analysis results: OR=2.71,95%CI:2.14-3.44,P<0.00001;2 years after surgery: OR=2.39,95%CI: 1.87-3.06,P<0.00001;3years after surgery: OR=1.83,95%CI: 1.56-2.15,P=0.0005;5 years after surgery:OR=1.64,95%CI: 1.38-1.96,P<0.00001),the difference was statistically significant.An independent analysis of risk factors affecting survival was performed.From the perspective of relapse-free survival rate after radical resection of HCC,tumor number and tumor diameter were important risk factors affecting RFS after radical resection of HCC,especially for patients with multiple nodular primary tumors and tumor diameter greater than 5cm,the difference was statistically significant.(Number of tumors:OR=1.55,95%CI: 1.32-1.81,P<0.00001;Tumor diameter ≥ 5cm: OR=1.49,95%CI:1.20-1.84,P=0.0002,sensitivity analysis results: OR=1.61,95%CI:1.41-1.84,P<0.00001).From the perspective of the cumulative survival after radical resection of liver cancer patients were analyzed,the results showed that high serum alpha fetoprotein(AFP)levels,incomplete tumor capsule,tumor diameter(≥5 cm)have a bad effect on the cumulative survival rate after radical resection of liver cancer,the difference was statistically significant(high serum AFP level: OR = 1.59,95% CI:1.33-1.89,P<0.00001.Tumor capsule incompleteness: OR=1.59,95%CI:1.11-2.26,P=0.01;sensitivity analysis results: OR=1.79,95%CI:1.46-2.19,P<0.00001.Tumor diameter ≥5cm: OR=1.51,95%CI: 1.14-2.02,P=0.004,sensitivity analysis results: OR=1.94,95%CI: 1.65-2.27,P<0.00001).In the included literature in this study,literature about tumors with a diameter of 5 cm or more were extracted,and the data were collected for subgroup analysis.The results of the meta-analysis suggest that for patients with hepatocellular carcinoma with tumor diameter ≥5cm with microvascular invasion,in the absence of large vessel invasion and metastasis elsewhere,sequential TACE treatment after radical hepatocarcinoma resection is 1 year and 3 years after surgery Both the recurrence-free survival rate and the cumulative survival rate were better than those of radical hepatocarcinoma surgery alone,and the difference was statistically significant(RFS 1 year after operation:OR=2.32,95%CI: 1.33-4.06,P=0.003;RFS after 3 years: OR=1.95,95%CI: 1.21-3.12,P=0.006;1 year after operation OS: OR=3.83,95%CI: 2.39-6.12,P<0.00001;3 years after operation OS: OR =1.91,95%CI: 1.10-3.34,P=0.02).Conclusion: After radical hepatocarcinoma resection,pathologically confirmed patients with microvascular invasion,sequential TACE treatment after surgery can benefit in terms of recurrence-free survival and cumulative survival at 1,2,3,and 5years.High serum AFP level,multiple nodular tumors,tumor diameter ≥5cm,and incomplete tumor envelope are related risk factors that affect the survival of patients with liver cancer combined with MVI after radical resection. |
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