TACE Combined With Thermotics Therapy For Primary Liver Neoplasms: A Systematic Review And Meta-analysis

Background: Primary liver neoplasms (PLN) is known as the king of cancer, which is aserious threat to people’s health in the world. It has the characteristic as following: hidden onset,long incubation period, highly malignant, rapid growth, strong aggressivity, and high recurrenceand mortality rate after treatment of the tumor. Its treatment has been the difficulty in clinical. It’salready lose the opportunity of surgery generally when symptoms of Liver cancer occured, andthere is a high risk rate of the postoperative recurrence. Transcatheter arterial chemoembolization(TACE) has been used widely in clinical practice, which is one of the preferred therapies forlocally advanced liver cancer, but its clinical effect is not ideal. In order to improve long-termsurvival rate and patients’ quality of life, it is researching in the comprehensive therapies withTACE for patients with primary liver cancer.Objective: To evaluate the clinical efficacy and safety of transcatheter arterialchemoembolization (TACE) combined with Thermotics Therapy (Thermotherapy) for primaryhepatic carcinomas, and to provide the reference for clinical practice and further research.Methods: We searched foreign databases as Cochrane Library, PubMed, EMBASE, Web ofScience and Chinese ones as CBM, CNKI, VIP and Wanfang with computer and also retrievedother sources as supplying, such as tracing related references. All relevant randomized controlledtrials (RCTs) were collected to compare combination therapy with TACE alone or Thermotherapyalone. Two investigators performed literature screening and data extraction according to theprotocal independently. After quality evaluation of included studies had been finished according tothe Cochrane criterion, meta-analyses were performed using the RevMan5.1software.Results: A total of1407relevant literatures have been obtained through the preliminaryretrieval, and a total of54RCTs were included after screening literatures. Besides two Englishpapers of SCI, the rest are all Chinese literatures. A total of3969patients were included.（1）Classified as argon-helium cryotherapy system (AHCS),16RCTs were included with1467patients involved. The results of meta-analysis showed:①The total effective rate, completenecrosis rate,0.5-1-1.5-2-2.5-year survival rate, the decrease of AFP and the increase of Th cell in the combination therapy group were superior to TACE alone, recurrence rate in the combinationgroup was lower than TACE alone; and there were all significant difference(P＜0.05). Theincidences of combination therapy was lower than TACE alone on the Myelosuppression, butthere was no significant difference (P＞0.05). The rate of Th/Ts was improved by combinationtherapy, but it was on the statistical critical value (P=0.05).②The0.5-1.5-2-2.5-year survival rate,the decrease of AFP and the increase of Th cell in the combination therapy group were superior toAHCS alone, and there were all significant difference (P＜0.05).（2）Classified as hyperthermia therapy (HT),18RCTs with979patients were included.Meta-analysis showed that comparing combination therapy with TACE alone, there weresignificant difference on the indicators of1-2-year survival rate, total effective rate andimprovement rate of life quality (P＜0.05), which were superior in the combination group. Theincidences of combination therapy was lower than TACE alone on the indicators ofMyelosuppression and Alimentary canal reactions, but there was statistically significant differenceonly on the incidence of Myelosuppression (P＜0.05).（3）Classified as high intensity focused ultrasou (HIFU), a total of20RCTs involving1523patients were included. Meta-analysis showed: The0.5-1-1.5-2-2.5-year overall survival rate andtotal effective rate in the combination therapy group were superior to TACE alone group, and therewere all statistically significant difference (P＜0.05). The incidences of combination therapy werelower than those of TACE alone on the indicators of Leukocytopenia, Nausea and Vomiting,Hepatic lesion, but there was statistically significant difference only on the indicator of Nauseaand Vomiting (P＜0.05). The incidence of fever was higher in the combination therapy group thanthe TACE alone group, and there was significant difference (P＜0.05).Conclusion: Compared with TACE or Thermotherapy alone, TACE combined withThermotherapy can signally improve long-term survival rate and short-term curative effect,ameliorate the quality of life, and improve the anti-tumour immunity for PLN. Additionally, it’sfeasible and its safety can be accepted. But its long-term survival rate and more comprehensivesecurity still needs to be further verified by more large sample and high quality RCTs.