title: Transarterial chemoembolization combination therapy vs monotherapy in unresectable hepatocellular carcinoma: a meta-analysis.
abstract: OBJECTIVE
  To perform a meta-analysis examining the efficacy of transcatheter arterial chemoembolization (TACE) alone or in combination with radiofrequency ablation (RFA), percutaneous ethanol injection (PEI), or high-intensity focused ultrasound (HIFU) for unresectable hepatocellular carcinoma (HCC).
  
  
  METHODS
  Medline, Embase, the Cochrane Library, and Google Scholar were searched through May 31, 2014, using the following keywords: hepatocellular carcinoma, transarterial chemoembolization, percutaneous ethanol ablation, percutaneous ethanol injection, radiofrequency ablation, and high-intensity focused ultrasound. Randomized controlled trials (RCTs) comparing 1- and 3-year mortality rates in patients with unresectable HCC receiving either TACE alone or TACE in combination with RFA, PEI, or HIFU were included. One- and 3-year survival rates were compared.
  
  
  RESULTS
  Eleven RCTs were included. The total number of patients ranged from 37 to 189, mean age ranged from 52 to 73 years, and percentage male ranged from 54% to 94%. Overall, TACE alone was associated with higher 1-year mortality than TACE combination therapies (pooled odds ratio [OR] 2.47, 95% confidence interval [CI] 1.37 to 4.43, p = 0.003). The 1-year mortality rate between TACE alone vs TACE + PEI was not different, but TACE + PEI was associated with a significantly lower 3-year mortality as compared to TACE alone (pooled OR 6.02, 95% CI 3.03 to 11.93, p&lt;0.001). The RFA alone was associated with higher 1-year mortality compared with TACE + RFA (pooled OR 2.20, 95% CI 1.11 to 4.32, p = 0.023).
  
  
  CONCLUSIONS
  Transcatheter arterial chemoembolization in combination with percutaneous ablation therapies may improve the survival of patients with unresectable HCC.
authors.affiliation: Intensive Care Unit, 302 Hospital of PLA, Beijing - China.
authors.forename: Lei
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Ultrasonography, 302 Hospital of PLA, Beijing - China.
authors.forename: Jiangke
authors.initials: J
authors.lastname: Tian
authors.affiliation: Department of Emergency, 302 Hospital of PLA, Beijing - China.
authors.forename: Peng
authors.initials: P
authors.lastname: Liu
authors.affiliation: Department of Endocrinology, 302 Hospital of PLA, Beijing - China.
authors.forename: Xuan
authors.initials: X
authors.lastname: Wang
authors.affiliation: Hepatoliliary Surgery Center, 302 Hospital of PLA, Beijing - China.
authors.forename: Zhenyu
authors.initials: Z
authors.lastname: Zhu
mesh_terms: D000279:Administration, Cutaneous; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects; D003131:Combined Modality Therapy / Q000379:methods; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006499:Hepatic Artery; D057086:High-Intensity Focused Ultrasound Ablation / Q000009:adverse effects; D006801:Humans; D008113:Liver Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D012597:Sclerosing Solutions / Q000008:administration & dosage*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D012597:Sclerosing Solutions; D000431:Ethanol