Meta-analysis Of The Efficacy Of Preventive TACE After Radical Resection Of Primary Liver Cancer

Objective:To evaluate the short-term and long-term efficacy of preventive transcatherter arterial chemoembolization(TACE)after radical resection of primary liver cancer(hereinafter referred to as liver cancer)and to explore the safety of preventive TACE in order to provide reference for clinical treatment.Methods:We collected the original research of preventive TACE after radical resection for liver cancer,and obtained published 2394 articles from built databases to November 2019 through computer searching foreign language databases Pubmed,Embase,The cochrane library,CNKI,Wanfang and other Chinese databases,analyzed the data obtained,and compared the difference of related indicators between the group of simple radical resection of liver cancer and the group of radical resection of liver cancer plus preventive TACE using the meta-analysis software Rev Man5.3 provided by the Cochrane Collaboration.The quality of retrospective studies was evaluated using the NOS scale,and the quality of randomized controlled trials was evaluated using the Cochrane Handbook.The chi-square test was used to test the heterogeneity among the studies.It indicated that the heterogeneity among the studies was large if P <0.1,I~2>50%,the random effects model was used,and it indicated that the heterogeneity among the studies was small if P>0.1,I~2<50%,the fixed effects model is adopted,the relative risk(RR)was used to analyze the data of various related indicators,and the confidence interval(CI)is 95%.It is considered statistically different when the P value is less than0.05.Results:Eleven articles were finally adopted,including 6 retrospective studies and 5 randomized controlled trials with a total of 1831 patients through screening,among them,there were 944 cases in the operation-only group and887 cases in the operation plus TACE group.The general datas of the surgery group and the surgery plus TACE group were not statistically different,and they were comparable.Forest plot showed that there was no statistical difference in the 1 year recurrence-free survival rate of the two groups,but the2,3,and 5 years recurrence-free survival rate of the surgery plus TACE group were significantly higher than that of the surgery alone group,with statistical difference were 2-year RR=1.51,95%CI(1.29-1.76),P<0.00001,3-year RR=1.52,95%CI(1.17-1.98),P=0.002,5-year RR=1.30,95%CI(1.04-1.62),P=0.02.Preventive TACE can improved the overall survival rate of 1,3,and 5years after surgery with statistical difference were 1-year RR=1.23,95%CI(1.16-1.31),P<0.00001,3-year RR=1.51,95%CI(1.23-1.86),P<0.0001,and5-year RR=1.41,95%CI(1.19-1.67),P<0.0001 respectively.Conclusion: Prophylactic TACE can improve the 2,3,and 5 years recurrence-free survival rate of patients with primary liver cancer and the 1,3,and 5 years overall survival rate of patients with primary liver cancer after radical resection.Prophylactic TACE is the best choice for 4 to 6 weeks after surgery.It is generally considered that the treatment effect of 1 to 3 times is better.The common complications are nausea,vomiting,fever,liver pain,liver damage,and there are fewer serious complications and better safety.Due to the lack of relevant data such as tumor size and microvascular invasion,if or not preventive TACE is effective for patients with small liver cancer and no microvascular invasion,it needs to be further confirmed by multi-center,large sample,long-term clinical randomized controlled trials.