The Efficacy And Safety Of Hepatic Resection Versus Transcatheter Arterial Chemoembolization In The Treatment Of Multiple Hepatocellular Carcinoma:A Meta-analysis

Background & ObjectiveThe aim of this meta-analysis is to investigate the efficacy and safety of hepatic resection versus TACE in the treatment of multiple hepatocellular carcinoma by comparing the long-term survival rate and incidence of major treatment-related complication of both modalities,thereby to provide hepatocellular carcinoma treatment in clinical practice with evidences.MethodsA comprehensive search by both computer and manual work was conducted in databases including PubMed,Embase,Cochrane Library,Web of Science,Google Scholar,ClinicalTrials.org,SinoMed,VIP,CNKI and Wanfang.Eligible trials from January 1989 to January 2017 that compared hepatic resection with TACE in the treatment of multiple hepatocellular carcinoma were identified double-blindly by two investigators and retrieval of references in these trials was also performed.The two investigators evaluated quality of the eligible trials and extracted required data.The primary endpoints are overall survival rate and one-year,three-year and five-year survival rate while the secondary endpoint is postoperative major treatment-related complications.The statistical package RevMan 5.3 and STATA 12.0 were used in this meta-analysis.ResultA total of 11 eligible trials containing 2929 patients were included.Comparison of hepatic resection and TACE demonstrated a statistically significant difference in the overall survival rate(HR = 0.58,95%CI: 0.47~0.71,P<0.05)and one-year(OR = 1.26,95%CI: 1.07~1.49,P = 0.006<0.05),three-year(OR = 1.99,95%CI: 1.48~2.68,P<0.05)and five-year(OR = 2.47,95%CI: 1.75~3.49,P<0.05)survival rate.Subgroup analysis revealed a statistically significant difference in BCLC A(HR = 0.42,95%CI: 0.33~0.53,P<0.05)and BCLC B(HR = 0.54,95%CI: 0.47~0.62,P<0.05)while a similar effect in BCLC C(HR = 0.74,95%CI: 0.47~1.16,P = 0.19>0.05).Nevertheless comparison of hepatic resection and TACE on postoperative major treatment-related complications revealed a difference that is not statistically significant(OR = 1.33,95%CI: 0.04~49.88,P = 0.88>0.05).ConclusionBased on this meta-analysis,hepatic resection is likely to improve the overall survival rate but will not increase the incidence of major treatment-related complications in the treatment of multiple hepatocellular carcinoma in BCLC A and BCLC B when compared to TACE.