| Primary hepatic carcinoma(PHC) is common malignant tumor in China. In recent two decades, due to the spread of hepatitis C virus infection in Western countries, the incidence of hepatocellular carcinoma continues to rise. Advanced hepatocellular carcinoma was often found because of its occult onset, so transcatheter arterial chemoembolization(TACE) therapy for hepatocellular carcinoma played an important role and good clinical results had been achieved. But still a considerable portion of the patients who were treated with TACE had poor efficacy. One of the reasons was the dual blood supply to hepatocellular carcinoma.The more close to the edge of the tumor, the more proportion of the blood supply that portal vein involved in. Therefore, in recent years transcatheter hepatic arterial chemoembolization combined portal vein embolization(PVE) have emerged. It is worth discovering whether this method could significantly improve the treatment efficacy of primary hepatic carcinoma and prolong survival time.Object: To investigate whether or not the method of TACE combined PVE could improve the treatment efficacy in patients with advanced hepatocellular carcinoma and prolong their survival time, and to provide scientific basis for clinician whether this treatment method is worth promoting.Information and methods:We collected all the domestic and foreign articles about the treatment of TACE and PVE for hepatocellular carcinoma. The database included Pubmed, Medline and CNKI. In the library of the Fourth Military University, We retrieved all the articles in the search-related fields and academic compilation of conference papers, contacted the authors for full text and precise data, traced literature that have been included in the references, collected all of the articles about randomized controlled trials (RCT) or non-randomized concurrent control trials (CCT) in the treatment of advanced hepatocellular carcinoma between TACE alone and TACE combined PVE before April, 2009. In accordance with criteria, we evaluated and selected the literature into the Meta-analysis.Selection criteria:The RCT and CCT between TACE alone and TACE combined PVE for advanced hepatocellular carcinoma patients who lost opportunities for primary surgery, whether or not to use the blind method. The initial diagnosis of hepatocellular carcinoma was not found with other malignant focuses.Results:A total of 10 literatures and 1078 cases were included. The extracted data were Meta analyzed by RevMan 5.0 software. The analysis results were as follows: (1) 0.5,1,2 and 3-year survival rates in experimental group patients were better than those in the control group. (2) Complete remission rates and partial remission rates of solid tumors of patients in the experimental group were better than those in the control group. (3) Disappearance rates and shrink rates of portal vein tumor thrombus in the experimental group were higher than those in the control group. (4) Alpha-fetoprotein (AFP) decrement rates by the value of 50% in the experimental group were higher than those in the control group. (5) Tumor-free non-embolized liver volume increment rates of patients in the experimental group were higher than those in the control group.Conclusion:This study suggests that the treatment of TACE combined PVE for hepatocellular carcinoma could improve the treatment efficacy, prolong the survival time and help patients to increase opportunities of the expansion radical resection to some extent. However, due to the current lack of data and RCTs about TACE combined PVE for advanced hepatocellular carcinoma in international major hospitals, the conclusion that obtained in the basis of a small number of samples looks forward to being verified by large sample RCT.
|
PDF Full Text Request