[Meta-analysis of the efficacy of transcatheter arterial chemoembolization combined with percutaneous ethanol injection in treating unresectable primary liver cancer].
OBJECTIVE
To evaluate the efficacy and safety of transcatheter arterial chemoembolization combined with percutaneous ethanol injection in treating unresectable primary liver cancer.


METHODS
MEDLINE (1966-June 2008), EMBASE (1974-June 2008), the Cochrane Library (Issue 2, 2008), CBMdisc (1978-June 2008), CNKI (1979-June 2008), and Wanfang Database were searched without language limitation. All randomized controlled trials comparing transcatheter arterial chemoembolization alone with transcatheter arterial chemoembolization combined with percutaneous ethanol injection for treating unresectable primary liver cancer were identified and screened by two reviewers, and the methodological quality of the included randomized controlled trials were evaluated by Jadad scale. The Cochrane Collaboration's RevMan4.2 software was used for the analysis of the data extracted from the included randomized controlled trials.


RESULTS
Fourteen randomized controlled trials involving 857 patients were included with 12 trials published in Chinese and 2 in English. Meta-analysis of the data extracted from the included randomized controlled trials showed that transcatheter arterial chemoembolization combined with percutaneous ethanol injection could significantly improve the overall survival rates compared with transcatheter arterial chemoembolization alone, with the corresponding relative risk (RR) values (95% CI) for the 1, 2, and 3-year survival of 1.37 (1.21 - 1.56), 1.74 (1.49 - 2.04), and 2.26 (1.70 - 3.02) respectively; and the RR alpha-feto-protein (AFP) negative conversion rate, AFP lowering rate, and tumor focus efficacy rate were 1.39 (1.24 - 1.56), 1.69 (1.38 - 2.07), and 1.56 (1.38 - 1.77) respectively. Side effects or adverse events related with transcatheter arterial chemoembolization were reported in 11 randomized controlled trials, mainly liver function impairment, fever, gastrointestinal symptom, and transient pain, and no major treatment-related complication or death was reported.


CONCLUSIONS
Compared with transcatheter arterial chemoembolization alone, transcatheter arterial chemoembolization combined with percutaneous ethanol injection significantly is a better approach in treating unresectable primary liver cancer, increasing the overall survival rate, AFP negative and lowering rates, and tumor response rate. However, the methodological quality of most reported randomized controlled trials is low.
Gu
Guo-Wen
GW
Liver Transplantation Center, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
Li
Xiang-Cheng
XC
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016461:Chemoembolization, Therapeutic; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D015552:Injections, Intralesional; D008113:Liver Neoplasms / Q000628:therapy*; D016896:Treatment Outcome
D000431:Ethanol