| Objective:The clinical efficacy of preoperative prophylactic TACE and postoperativ e TACE in patients with resected primary hepatocellular carcinoma is still controve rsial.The purpose of this paper was to evaluate the rapeutic effects of preoperative prophylactic TACE and postoperative TACE for the resectable primary hepatocellula r carcinoma patients by Mata analysis.Methods:The research was conducted by retrieving China biomedical literature database,Chinese CNKI, VIP, Wanfang and Pub Med, OVID, Embase, Cochrane library.All literatures were selected by the end of January 2016.Two reviewers screen and extract the dates from those literatures.Randomized controlled trials were evaluated by using the modified Jadad score and the case-control study were evaluated by using the Newcastle-Ottawa Scale respectively.All trials involved were analyzed by Stata12.0.Results:The primary hepatocellular carcinoma patients were divided into two groups based on treatment methods. One group were treated by preventive TACE before hepatic resection. The other group were treated by hepatic resection only.A total number of 2316 patients were included in the comparison of two groups which consisted of 3 randomized controlled trial(RCT) articles and 8 case-control articles.(In these patients,752 patients comes from the preoperative prophylactic TACE groups and 1564 patients from the group who treated by liver resection only).There was no significant difference in the operation time and the amount of bleeding between the two groups(operation time:SMD=0.058,95%CI:-0.166,0.050,P=0.290;the amount of bleeding:SMD=-0.098,95%CI:-0.204,-0.08,P=0.070).The hospital stay was slightly increased in the preoperative prophylactic TACE groups(SMD=-0.86,95%CI:-1.57,-0.14,P=0.02).There was no significant difference between two groups in the 3-year overall survival and 5-year overall survival(the 3-year overallsurvival:RR=1.039,95%CI:0.964,1.121,P=0.314;the 5-year overall survival:RR=0.96,95%CI:0.86,1.08,P=0.505;).A total of 2184 patients from 1 andomized controlled trial(RCT) 1 article and 14 case-control article were included to compare the treatment effects in the HCC patients.Those patients were divided into two groups based on the treatment method.469 cases were included in the hepatic resection only group and 1087 cases were in the postoperation TACE group.The results showed that postoperative TACE can improve the 1 year survival for the primary hepatocellular carcinoma.The subgroup analysis was conducted by the following situations(Tumor diameter greater than 5cm; Multiple nodules and Blood vessel invasion).The results showed that postoperative TACE was able to play an important role in the risk factor group(the subgroup analysis in the no risk factor group:R R=1.10,95%CI:0.97,1.25,P=0.140;the subgroup analysis in the risk factor group: RR=1.16,95%CI:1.02,1.32,P=0.028).Postoperative TACE can significantly improve the three year survival rate in the postoperative TACE groups(RR=1.33,95%CI:1.15,1.53,P=0.000),but the five year survival rate had no significant effect between the two groups(RR=1.21,95%CI:0.95,1.15,P=0.124).Conclusion:1.the Preoperative TACE can’t reduce the operation time and intraoperative blood loss,and the long-term survival rate also has no obvious improvement,but prolong the length of stay. 2. Postoperative TACE can prolong The 1 year and 3 year survival rate of patients with primary hepatocellular carcinoma, especially including the following risk factors(Tumordiameter larger than 5cm;Multiple nodules; Vessel invasion) in the operation.Postoperative TACE can be recommended as a routine therapeutic method. |
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