Sorafenib Plus Transcatheter Arterial Chemoembolization To Treat Liver Cancer:a Meta-analysis

Background:In recent years,targeted drugs in combination with Transcatheter arterial chemoembolization（TACE）in the treatment of liver cancer clinical research emerge in endlessly,also concern about its efficacy and safety.However,targeted drugs combined with TACE therapy and TACE therapy alone,its efficacy and safety still have considerable controversy whether there are significant differences,and no clear evidence of evidence-based medicine for the present.Objective:This study intends to use Meta analysis method to evaluate targeted drugs Sorafenib combined with TACE treatment of liver cancer efficacy and safety,provide a reference basis for further clinical practice.Methods:Computer retrieval before December 2017 Ovid,PubMed,the Cochrane Library,the Chinese biomedical literature database（CBM）,Chinese journal full-text database（CNKI）of science and technology,China journal full-text database（VIP）,a database of ten thousand,manually literature retrieval.Using Meta analysis method for Objective efficient（Objective response rate,ORR）,the Clinical benefit rate（Clinical practice rate,CBR）,survival rate and incidence of adverse reactions such as indicators for evaluation.RevMan5.3 software into the literature on the data extraction and Meta analysis.Using fixed effect OR random effect model of"Odds ratio（Odds thewire,OR）","relative Risk than（Risk ratio,RR）"and its 95%Confidence interval（the Confidence interval,CI）and data statistical analysis,to study and to explore its heterogeneity,sensitivity and the Risk of bias.Among them,we use Q test to detect the size of the heterogeneity,such as included in the study（P≥0.1,I²≤50%）,says it does not exist obvious heterogeneity,the use of fixed effects model is analyzed,in terms of the using random effect model to analyze it.The literature into the data extraction,using RevMan5.3 software for statistical analysis,to explore its heterogeneous and sensitivity and funnel chart publication bias.Results:In this paper,a total of a randomized controlled study of paper into the19th,the cumulative total of 2070 patients with liver cancer,the treatment group accept Sorafenib combined with TACE treatment for 1031 cases,number of cases in the control group treated with TACE alone or with TACE+placebo number is1039.By RevMan5.3 software Meta analysis was carried out on the extracted data,the results showed that:the treatment group compared with control group,its curative effect has increased,there are significant difference statistically significant,the objective and efficient[OR_ORR=2.18,95%CI:2.18,1.75,P<0.00001];Clinical benefit rate[OR_CBR=3.02,95%CI:3.02,2.04,P<0.00001];6 months survival[OR_6months=5.42,95%CI:5.42,13.71,P=0.0004).12 months survival[OR_{12 months}=3.82,95%CI:2.78,5.25,P<0.00001).Use former VEFG rate without statistical significance[SMD _{medication before}=0.28,95%CI:32.06,31.50,P=0.99];After VEFG rate have obvious statistical significance[SMD _{medication after}=145.55,95%CI:174.71,116.39,P<0.00001).Compared with control group,treatment group adverse reactions in the hand,foot and skin reactions（HFSR）,hypertension,the incidence of diarrhea,skin rash,fatigue were significantly statistical difference,P values were less than 0.05,the brothers skin reaction[RR_HFSR=8.13,95%CI:8.13,5.67,P<0.00001];Diarrhea[RR _diarrhea=3.52,95%CI:2.68,4.62,P<0.00001];Hypertension[RR _hypertension=2.73,95%CI:1.98,3.78,P<0.00001];The rash[RR _rash=3.28,95%CI:3.28,4.60,P<0.00001];Fatigue[RR_fatigue=1.24,95%CI:1.02,1.50,P=0.03).Conclusion:Meta analysis showed that Sorafenib combined with TACE treatment of liver cancer patients and compared with TACE treatment alone,combined treatment can significantly enhance the objective effectiveness of liver cancer patients,the clinical benefit rate and survival situation 6 months and 12months of survival.Combination therapy,however,produced by the high incidence of side effects than medication alone,can be considered as a combination treatment of potential limitations,but by reducing the drug dosage or adverse reactions can be reduced or relieved after symptomatic treatment,the patients tolerated,within the scope of the safety of the treatment.