title: Combination of radiofrequency ablation with transarterial chemoembolization for hepatocellular carcinoma: a meta-analysis.
abstract: BACKGROUND
  Recent studies suggest that the combination of radiofrequency ablation (RFA) and transarterial chemoembolization (TACE) may have a synergistic effect for hepatocellular carcinoma (HCC).
  
  
  OBJECTIVE
  The aim of this meta-analysis was to compare the effectiveness of combination of RFA and TACE with that of RFA alone in patients with HCC.
  
  
  METHODS
  Randomized controlled trials and retrospective cohort studies comparing RFA plus TACE with RFA alone for HCC were included into this meta-analysis. Study quality was rated with a standardized scale and the strength of evidence was also rated by using the grading of recommendations assessment, development, and evaluation system (GRADE system).
  
  
  RESULTS
  Meta-analyses showed that the combination of RFA and TACE was obviously associated with higher survival rates (odds ratio [OR](1-year) = 2.14, 95 % confidence interval [95 % CI] 1.57-2.91, P < 0.001; OR(3-year) = 1.98, 95 % CI 1.28-3.07, P = 0.001; OR(5-year) = 2.70, 95 % CI 1.42-5.14, P = 0.003). The overall quality of evidence was judged to be low by using the GRADE system.
  
  
  CONCLUSIONS
  The combination of TACE with RFA can improve the overall survival rate and provides better prognosis for patients with HCC, but more randomized controlled trials using large sample size are needed to provide sufficient evidence.
authors.affiliation: Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, China.
authors.forename: Shushan
authors.initials: S
authors.lastname: Yan
authors.forename: Donghua
authors.initials: D
authors.lastname: Xu
authors.forename: Beicheng
authors.initials: B
authors.lastname: Sun
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D003131:Combined Modality Therapy; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*