Prognostic Significance Of Adjuvant Tace After Curative Resection Of Hepatocellular Carcinoma:a Meta Analysis

BACKGROUND:Whether transcatheter chemoembolization(TACE)adjuvant therapy for radical hepatectomy in patients with hepatocellular carcinoma(HCC)can improve prognosis is still controversial.OBJECTIVE:A meta-analysis of the efficacy of simple radical resection of HCC and postoperative adjuvant TACE was conducted by collecting relevant data and literature to evaluate the effect of adjuvant TACE on the prognosis of patients with HCC.METHODS:Searching foreign language databases through computer network systems:PubMed,Cochrane library,OVID,Chinese databases:Chinese Academic Journal Full-text Database(CNKI),Chinese Biomedical Literature Database(CBM),and Wanfang Database were searched to include prospects that meet the inclusion criteria.A randomized,controlled clinical study was conducted to evaluate the quality of the articles included according to the modified Jadad score criteria.RevMan 5.3 software was used to process the data.I~2 statistics was used to test the heterogeneity of the included literature,using either fixed or random effects models for analysis.Data analysis was performed using relative risk(RR)and 95%confidence interval(CI),P<0.05 was considered statistically significant.Forest maps were used to represent the results of the meta-analysis.We analyzed 1,3,and 5 years overall survival rate,recurrence free survival.Funnel plot were used to analysis for publication bias.P<0.05 was considered statistically significant.RESULTS:Eleven articles were eventually included,including six Chinese articles and five English articles.A total of 843 patients were enrolled,including 442 patients undergoing single hepatectomy(LR group),401 patients undergoing hepatectomy and postoperative TACE(TACE group).Control and experimental groups of each study were no significant difference in age,sex,number of hepatitis B positive cases,size of tumors,number of tumors,and liver function.The baseline between the groups was good.The improved Jadad score ranged from 2 to 5 points.The results showed that there was no significant difference in the1-year RFS between the two groups.Postoperative TACE had no significant effect on postoperative 1-year RFS(RR=1.13;95%CI(0.89,1.44),P=0.32);3 and 5 years RFS were statistically significant between the two groups.Postoperative TACE had a significant effect on postoperative 3-and 5-year RFS.1-year(RR=1.36;95%CI(1.02,1.80);and P=0.03),3-year(RR.=1.73;95%CI(1.23,2.44);P=0.002).1-,3-,and 5-year OS were statistically significant between the two groups,and postoperative TACE had a significant effect on postoperative OS of 1-,3-,and 5-years after surgery.1-year(RR=1.30;95%CI(1.09,1.56);P=0.004),3-year(RR=1.55;95%CI(1.08,2.22);P=0.02),5year(RR=1.91;95%CI(1.36,2.67);P=0.0002).CONCLUSIONS:TACE treatment after radical resection of HCC can improve postoperative 1-,3-,and 5-year OS and 3-,5-year RFS;...