title: Transarterial (chemo)embolization for curative resection of hepatocellular carcinoma: a systematic review and meta-analyses.
abstract: OBJECTIVE
  To assess the beneficial and harmful effects of transarterial embolization (TAE) or transarterial chemoembolization (TACE) for curative resection of hepatocellular carcinoma (HCC).
  
  
  METHODS
  The authors conducted an extensive search of studies on this strategy. All randomized controlled trials comparing TACE or TAE plus operation versus operation only were considered for inclusion, regardless of blinding, language, or publication status. Results were performed with disease-free survival (DFS) and overall survival (OS) as the primary endpoint. Tumor response and adverse events were secondary endpoints.
  
  
  RESULTS
  A total of 10 studies involving 909 HCC participants finally fulfilled the predefined inclusion criteria. Four trials assessed preoperative TACE versus control and six trials assessed postoperative TACE versus control. There were significant improvements for DFS [HR 0.62 (95 % CI 0.49-0.79)] and OS [HR 0.60 (0.46-0.79)] in the postoperative TACE compared with the control when the mean tumor size was bigger than 5 cm. However, preoperative TACE did not improve DFS [HR 0.92 (0.71-1.20)] and OS [HR 1.07 (0.78-1.46)] for curative resection of HCC. Substantial differences in criteria for assessing tumor response did not allow quantitative analyses. Fever (26.7-85.9 %), abdominal pain (19.3-71.2 %), and nausea/vomiting (27.4-66.3 %) were common adverse events. Relatively rare but more serious complications were also reported.
  
  
  CONCLUSIONS
  Postoperative TACE offers potential benefits for curative resection of HCC when the mean tumor size is bigger than 5 cm.
authors.affiliation: Hepatobiliary Surgery Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Cheng
authors.forename: Ping
authors.initials: P
authors.lastname: Sun
authors.forename: Qing-Gang
authors.initials: QG
authors.lastname: Hu
authors.forename: Zi-Fang
authors.initials: ZF
authors.lastname: Song
authors.forename: Jun
authors.initials: J
authors.lastname: Xiong
authors.forename: Qi-Chang
authors.initials: QC
authors.lastname: Zheng
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000628:therapy*; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D016019:Survival Analysis
references.citation: Ann Surg. 2008 Jan;247(1):43-8
references.pmid: 18156922
references.citation: Eur J Cancer. 2009 Jan;45(2):228-47
references.pmid: 19097774
references.citation: Am J Surg. 2009 Sep;198(3):313-8
references.pmid: 19285298
references.citation: Hepatology. 1994 Aug;20(2):295-301
references.pmid: 8045490
references.citation: Dig Dis Sci. 2012 May;57(5):1404-12
references.pmid: 22271410
references.citation: Hepatogastroenterology. 1996 Nov-Dec;43(12):1404
references.pmid: 8975938
references.citation: Ann Surg. 2003 Feb;237(2):171-9
references.pmid: 12560774
references.citation: Hepatology. 1998 Jun;27(6):1578-83
references.pmid: 9620330
references.citation: Chin Med J (Engl). 1999 Oct;112(10):887-91
references.pmid: 11717970
references.citation: Aliment Pharmacol Ther. 2003 May 15;17(10):1247-61
references.pmid: 12755838
references.citation: Ann Intern Med. 2001 Dec 4;135(11):982-9
references.pmid: 11730399
references.citation: J Hepatol. 2001 Sep;35(3):421-30
references.pmid: 11592607
references.citation: Liver Int. 2010 Feb;30(2):166-74
references.pmid: 19912531
references.citation: Ann Intern Med. 2009 Aug 18;151(4):264-9, W64
references.pmid: 19622511
references.citation: World J Gastroenterol. 2009 Sep 28;15(36):4582-6
references.pmid: 19777619
references.citation: Aliment Pharmacol Ther. 2010 Aug;32(3):344-55
references.pmid: 20497143
references.citation: Trials. 2007 Jun 07;8:16
references.pmid: 17555582
references.citation: Jpn J Cancer Res. 1996 Feb;87(2):206-11
references.pmid: 8609071
references.citation: J Cancer Res Clin Oncol. 2009 Oct;135(10):1437-45
references.pmid: 19408012
references.citation: Gastroenterology. 2004 Nov;127(5 Suppl 1):S35-50
references.pmid: 15508101
references.citation: J Cancer Res Clin Oncol. 1995;121(6):364-6
references.pmid: 7541051
references.citation: Hepatology. 2003 Feb;37(2):429-42
references.pmid: 12540794
references.citation: World J Gastroenterol. 2004 Jan 15;10(2):190-4
references.pmid: 14716820
references.citation: JAMA. 1995 Feb 1;273(5):408-12
references.pmid: 7823387
references.citation: Int J Cancer. 2010 Dec 15;127(12):2893-917
references.pmid: 21351269
references.citation: Cancer. 1993 Jan 1;71(1):19-25
references.pmid: 8380116
references.citation: Ann Surg. 2009 Feb;249(2):195-202
references.pmid: 19212170
references.citation: BMC Gastroenterol. 2013 Mar 19;13:51
references.pmid: 23509884
references.citation: J Natl Cancer Inst. 2000 Feb 2;92(3):205-16
references.pmid: 10655437
references.citation: BMJ. 2008 Mar 15;336(7644):601-5
references.pmid: 18316340
references.citation: Clin Exp Metastasis. 1988 Mar-Apr;6(2):121-9
references.pmid: 3345611
references.citation: Eur J Surg Oncol. 2012 Apr;38(4):286-95
references.pmid: 22281155
references.citation: Control Clin Trials. 1990 Oct;11(5):339-52
references.pmid: 1963128
references.citation: Br J Surg. 1995 Jan;82(1):122-6
references.pmid: 7881929
references.citation: Lancet. 1998 Aug 22;352(9128):609-13
references.pmid: 9746022
references.citation: Hepatology. 2011 Mar;53(3):1020-2
references.pmid: 21374666
references.citation: Br J Surg. 2001 Apr;88(4):515-22
references.pmid: 11298618
references.citation: Hepatobiliary Pancreat Dis Int. 2002 Feb;1(1):35-41
references.pmid: 14607620
references.citation: Stat Med. 1998 Dec 30;17(24):2815-34
references.pmid: 9921604
references.citation: Hepatol Res. 2010 Oct;40(10):943-53
references.pmid: 20887328
references.citation: Ann Surg. 2000 Jul;232(1):10-24
references.pmid: 10862190
references.citation: Dig Surg. 2006;23(4):235-40
references.pmid: 16943671