The Efficacy Of TACE And Portal Vein Stents Combined Endovascular Implant Iodine-125 Seeds Strand For Treatment Hepatocellular Carcinoma With Main Portal Vein Tumor Thrombus: A Meta-Analysis

ObjectiveThis meta-analysis was designed to investigate the efficacy and safety of TACE and portal vein stenting combined endovascular iodine-125 seeds strand implantation versus TACE and portal vein stenting alone for the treatment hepatocellularcarcinoma with main portal vein tumor thrombus,thus to provide clicinal practice with powerful basis and support.MethodsA comprehensive search by both computer and manual work was conducted in Pub Med,Embase,Cochrane Library,Web of Science,Sino Med,VIP,CNKI and Wanfang.Eligible trials from 1997 to 2017 that compared TACE and portal vein stenting combined endovascular iodine-125 seeds strand implantation versus TACE and portal vein stenting alone for the treatment hepatocellular carcinoma with main portal vein tumor thrombus were identified by two investigators and retrieval of references in eligible trials was also performed.The two investigators evaluated quality of the eligible trials and extracted required data.The primary endpoints are the6-month,1-year stent cumulative patency rate and 6-month,1-year and 2-year overall survival rate while the secondary endpoint are the effective rate of reduction of intrahepatic tumor size and major treatment-related complications.Statistical package Rev Man 5.3 was used in this meta-analysis.ResultsA total of 7 eligible trials containing 944 patients were included,in which 565 patients received TACE and portal vein stenting combined endovascular iodine-125 seeds strand implantation(research group)while the other 379 patients are TACE and portal vein stenting alone(control group).Meta-analysis revealed that the research group had advantages in 6-month [OR =3.04,95% CI(1.84,5.04),P<0.0001],1-year[OR= 4.10,95% CI(2.93,5.14),P<0.00001] stent cumulative patency rate and6-month [OR= 3.25,95% CI(2.45,4.31),P<0.00001],1-year [OR= 4.17,95% CI(2.90,5.99)P<0.00001],and 2-year [OR=7.44,95% CI(3.46,16.00),P<0.00001]survival rate over control group,which demonstrated a statistically significant difference.However the difference between both groups in terms of intrahepatic tumor therapeutic response [OR =1.28,95% CI(0.92,1.78),P=0.15] was not statistically significant.ConclusionTACE and portal vein stenting combined endovascular iodine-125 seeds strand implantation can significantly increase stent cumulative patency rate and improve the survival rate for hepatocellular carcinoma patients with main portal vein tumor thrombus.However,given the limitations of study quantity,well-designed randomized controlled trials should be warranted to confirm these findings.