TACE Combined With Mwa Versus Simple TACE For The Treatment Of Advanced Liver Cancer:a Meta-analysis

Background Primary hepatocellular carcinoma(PHC)is one of the most common malignant tumors in China.It is the second leading cause of cancer death.It is one of the important causes of increasing disease burden and seriously threatens the life and health of Chinese people.There are three pathological types of primary hepatocellular carcinoma(PHC),including hepatocellular carcinoma(HCC),intrahepatic cholangiocarcinoma(ICC)and a combination of the two.Among them,the HCC accounts for 85-90%,with a high degree of malignancy and strong invasion and metastasis.In addition,due to the concealment of early onset,patients usually have no typical symptoms or signs.Once symptoms or signs are present,it is already the stage of progression or late stage,thus losing the best opportunity for surgery.At present,there is a consensus at home and abroad that these patients usually choose Transcatheter arterial chemoembolization(TACE)for treatment.However,only TACE treatment usually affects some tumor cells,the tumor load is still large;the median survival time of patients is very limited,and the therapeutic effect is not very ideal.Therefore,in recent years,more and more domestic researchers have been exploring and attempting to conduct randomized controlled trials of TACE combined Microwave ablation(MWA)therapy,to study or utilize the combined treatment advantages of TACE and MWA to further extend the median survival of patients.Objective Meta-analysis was performed to compare the efficacy and safety of TACE combined with MWA and TACE alone in the treatment of Primary hepatocellular carcinoma,to explore the advantages of combined treatment,to improve the median survival of patients,and to provide a better evidence-based basis for the selection of appropriate treatment for clinical the primary hepatocellular carcinoma and to guide clinical work.Methods Literature on TACE combined with MWA and TACE alone in the treatment of primary liver cancer were searched by computer on PubMed,Web of science,Cochrane Library,CNKI,WanFang and other databases,and the publication time was limited to January 2001 to December 2019.Then,the literature that met the requirements was selected and meta-analyzed.Our evaluation indexes included:(1)serum alphafetoprotein(AFP)levels before and after surgery;(2)Solid tumor response evaluation,including: complete remission(CR),partial remission(PR),progressive diseases(PD),stable diseases(SD),and overall response rate [(CR+PR)/total number of people ×100%];(3)Survival rate(1 year,2 years,3 years);(4)The occurrence of complications after treatment.Results A total of 25 qualified literatures were selected with 5135 cases of advanced liver cancer,including 2584 cases on TACE combined with MWA group and 2551 cases on TACE alone.The results of metaanalysis showed:(1)Before and after the operation,the AFP level of both the TACE combined MWA group and the TACE group decreased significantly,but the decrease radian of the TACE combined MWA group was more significant [SMD=-1.48,95%CI(-2.16,-0.80),P<0.05].The difference between the two groups AFP of before and after the operation was statistically significant.(2)Efficacy evaluation of solid tumor treatment: the TACE combined MWA group compared with the TACE group,CR[RR=2.00,95% CI(1.69,2.37),P< 0.05],PR[RR=1.24,95% CI(1.11,1.40),P< 0.05] and the overall response rate [RR=1.44,95%CI(1.34,1.55),P< 0.05] were higher,but SD [RR=0.62,95% CI(0.52,0.74),P< 0.05] and PD [RR=0.53,95% CI(0.41,0.70),P< 0.05] were lower.The differences between the two groups were statistically significant.(3)Survival time: the 1-year survival rate [RD=0.18,95% CI(0.15,0.20),P< 0.05],2-year survival rate [RD=0.24,95% CI(0.22,0.26),P< 0.05],and 3-year survival rate [OR=2.80,95% CI(1.97,3.99),P< 0.05] were all higher in the TACE combined with MWA group than in the TACE group,and the differences between the two groups were statistically significant.(4)After treatment,all kinds of common complications occurred in both groups,but no very serious complications occurred,and the safety on the two groups was high.Conclusion Combined treatment of TACE and MWA has a synergistic effect and a stable safety.In addition,compared with TACE treatment alone,patients with TACE combined with MWA sequential therapy have the advantages of better the short-term efficacy of tumors and longer overall survival time,which is worthy of being widely used in clinical practice.