title: Radiofrequency ablation plus chemoembolization versus radiofrequency ablation alone for hepatocellular carcinoma:  a meta-analysis of randomized-controlled trials.
abstract: BACKGROUND
  There is a continuing debate on whether transcatheter arterial chemoembolization (TACE) plus radiofrequency ablation (RFA) is more effective than RFA alone in the treatment of patients with hepatocellular carcinoma (HCC). We carried out this meta-analysis of randomized-controlled trials to provide greater clarity on whether RFA plus TACE was more effective than RFA alone for HCC.
  
  
  METHODS
  A literature search was carried out for all possible randomized-controlled trials. The outcomes were overall survival rates and major complications. Data were abstracted using standardized forms, and an overall rating of the quality of evidence was assigned using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria. We estimated summary odds ratio (OR) with its 95% confidence interval (95% CI) to assess the effects.
  
  
  RESULTS
  Seven randomized-controlled trials were included. Meta-analysis showed that RFA plus TACE significantly improved the survival rates of patients with HCC at 1 and 3 years (for the one-survival rate, fixed-effects OR=2.71, 95% CI 1.65-4.43, P<0.0001; for the three-survival rate, fixed-effects OR=2.27, 95% CI 1.57-3.27, P<0.0001) compared with RFA alone. There was no difference in terms of major complications (fixed-effects OR=1.26, 95% CI 0.33-4.77, P=0.73). Subgroup analyses by tumor size showed that RFA plus TACE significantly improved the survival rates at 1, 3, and 5 years compared with RFA alone in patients with HCC larger than 3 cm; however, there was no advantage of TACE plus RFA over RFA alone for patients with HCC smaller than 3 cm. The quality of evidence was high for the 1-year survival rate, the 3-year survival rate, and major complications. No evidence of publication bias was observed.
  
  
  CONCLUSIONS
  High-quality evidence suggests that TACE plus RFA improve the survival rates compared with RFA alone for patients with HCC larger than 3 cm.
authors.affiliation: Department of Radiology, Shengjing Hospital of China Medical University, Heping District, Shenyang, China.
authors.forename: Zaiming
authors.initials: Z
authors.lastname: Lu
authors.forename: Feng
authors.initials: F
authors.lastname: Wen
authors.forename: Qiyong
authors.initials: Q
authors.lastname: Guo
authors.forename: Hongyuan
authors.initials: H
authors.lastname: Liang
authors.forename: Xiaonan
authors.initials: X
authors.lastname: Mao
authors.forename: Hongzan
authors.initials: H
authors.lastname: Sun
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D016896:Treatment Outcome