title: Transarterial chemoembolization (TACE) plus percutaneous ethanol injection (PEI) for the treatment of unresectable hepatocellular carcinoma: a meta-analysis of randomized controlled trials.
abstract: Transarterial chemoembolization (TACE) plus percutaneous ethanol injection (PEI) have been used for patients with unresectable hepatocellular carcinoma (HCC). However, whether the combination therapy of TACE plus PEI is better than TACE or PEI alone in the treatment of HCC remains controversial. Thus, we conducted this meta-analysis to assess the efficacy of combined therapy for unresectable HCC compared with that of TACE or PEI alone. Randomized controlled trials (RCTs) published from Pubmed, Embase, Web Of Science, Chinese Biomedical Literature database (SinoMed), China National Knowledge Infrastructure (CNKI), and Wanfang database, were systematically reviewed to assess the survival benefits and tumor recurrence for HCC patients treated with TACE plus PEI. Pooled risk ratio (RR) with 95% confidence intervals (95% CIs) for survival rate and tumor recurrence rate were calculated using a random-effects or fixed-effects model, depending on the heterogeneity between the included studies. 19 RCTs met the inclusion criteria were included in this meta-analysis with a total number of 1948 patients. The pooled results showed that the combination therapy of TACE plus PEI significantly improved 1, 2, 3-year survival rate [RR1-year = 1.24, 95% CI: 1.17-1.31, P = 0.000; RR2-year = 1.64, 95% CI: 1.44-1.87, P = 0.000; RR3-year = 2.27, 95% CI: 1.93-2.67, P = 0.000] compared with that of TACE or PEI alone. The local tumor recurrence rate in HCC patients treated with TACE plus PEI was lower than that of monotherapy (RR = 0.53, 95% CI: 0.29-0.96; P = 0.035). The combined therapy of TACE with PEI also significantly reduced the AFP level (RR = 1.40, 95% CI: 1.19-1.66, P = 0.000) and tumor size (>50%) (RR = 1.61, 95% CI: 1.40-1.85, P = 0.000). This meta-analysis confirms the benefits of TACE + PEI in the treatment of unresectable HCC, with an improvement in survival rate, and a reduction in local tumor recurrence, AFP level, and tumor size.
authors.affiliation: Department of Oncology, Hubei Province Hospital of TCM Xiangyang 441000, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Fu
authors.affiliation: Department of Liver Surgery, Hubei Province Hospital of TCM Xiangyang 441000, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Clinical Laboratory, Hubei Province Hospital of TCM Xiangyang 441000, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Yun
authors.affiliation: Department of Oncology, Hubei Province Hospital of TCM Xiangyang 441000, China.
authors.forename: Xueming
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Department of Radiology, Hubei Province Hospital of TCM Xiangyang 441000, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhu
authors.affiliation: Department of Oncology, Dongfang Hospital, The Second Clinical Medical College of Beijing University of Chinese Medicine Beijing 100078, China.
authors.forename: Quanwang
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Oncology, Dongfang Hospital, The Second Clinical Medical College of Beijing University of Chinese Medicine Beijing 100078, China.
authors.forename: Kaiwen
authors.initials: K
authors.lastname: Hu
authors.affiliation: Departemnt of Internal Medicine, Caner Hospital Chinese Academy of Medical Sciences Beijing 100021, China.
authors.forename: Jinwan
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Oncology, Dongfang Hospital, The Second Clinical Medical College of Beijing University of Chinese Medicine Beijing 100078, China.
authors.forename: Zhanbing
authors.initials: Z
authors.lastname: Qiao
keywords: Transarterial chemoembolization; hepatocellular carcinoma; meta-analysis; percutaneous ethanol injection