Preoperative transarterial chemoembolization for resectable hepatocellular carcinoma in Asia area: a meta-analysis of random controlled trials.
OBJECTIVE
We aimed to systematically evaluate the influence of preoperative transarterial chemoembolization (TACE) for resectable hepatocellular carcinoma (HCC) on long-term prognosis and perioperative safety.


METHODS
Databases including PubMed, Embase, Cochrane, Wanfang, CNKI, VIP data were searched, combined with Manual Retrieval and Cited Reference Search to collect the published randomized controlled trial (RCT) about the influence of pre-TACE for curative resection of HCC. The searching cutoff date was 2016/02/25, all the data obtained were statistically analyzed using RevMan5.2 software recommended by Cochrane Collaboration.


RESULTS
A total of 5 RCT including 430 (pre-TACE group: 212, surgery alone group: 218) patients were included. The results of meta-analysis showed that: there was no difference between the 2 groups on overall survival (OS) rate [HR 1.25, 95%CI (0.92-1.68)], disease free survival (DFS) rate [HR 0.95 (0.76-1.19)], perioperative mortality rate [OR 0.70 (0.22-2.30)], or blood loss [SMD 0.07 (-0.14-0.29)], whereas the subgroup analysis revealed that pre-TACE would result in longer operation time [SMD 0.31 (0.06-0.57)], higher postoperative morbidity rate [OR 1.90 (1.02-3.53)] and combined resection rate of perihepatic organs [OR 5.46 (2.73-11.78)] in subgroup with mean tumor diameter >5cm.


CONCLUSIONS
According to our study, pre-TACE treatment cannot improve the long-term prognosis of resectable HCC. With the growth of the tumor diameter, especially when it is over 5cm, it might add difficulties to surgery and affect the perioperative safety.
a Department of General Surgery , Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China.
Tengfei
T
Si
a Department of General Surgery , Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China.
Yongjun
Y
Chen
a Department of General Surgery , Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China.
Di
D
Ma
a Department of General Surgery , Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China.
Xiaoyong
X
Gong
a Department of General Surgery , Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China.
Kui
K
Yang
a Department of General Surgery , Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China.
Ruoyu
R
Guan
a Department of General Surgery , Ruijin Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China.
Chenghong
C
Peng
D001208:Asia; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D018572:Disease-Free Survival; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D016896:Treatment Outcome
Hepatocellular; meta-analysis; resectable; transarterial