title: Thalidomide combined with transcatheter artierial chemoembolzation for primary hepatocellular carcinoma: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Transcatheter arterial chemoembolization (TACE) and thalidomide have been used for treating primary hepatocellular carcinoma(HCC). This study aims to evaluate the clinical efficacy and safety of thalidomide and TACE in primary HCC.
  
  
  METHODS
  Randomized controlled trials(RCTs) about efficacy and safety of thalidomide combined with TACE for primary HCC were identified from the Cochrane Library, Pubmed, Embase, CNKI, and Wan Fang until August, 2016. The retrieved trials were reviewed and the data were extracted by two reviewers, independently. Combined analyses of survival rates, overall response rate(ORR), disease control rate(DCR), changes of KPS, parameters of cellular immunity and vascular endothelial growth factor(VEGF), and adverse events were performed using RevMan 5.3 software.
  
  
  RESULTS
  A total of 23 RCTs involving 1836 patients were included. The results showed that thalidomide plus TACE was significantly superior in increasing 6-month survival rate(OR=1.79, 95% CI:1.02-3.15, P=0.04), 1-year survival rate(OR=1.76, 95% CI:1.38-2.24, P<0.0001), 1.5-year survival rate(OR=4.72, 95% CI:2.64-8.43, P<0.001), 2-year survival rate(OR=1.78, 95% CI:1.37-2.30, P<0.001), ORR(OR=1.89, 95% CI:1.48-2.42, P<0.0001), DCR(OR=2.62, 95% CI:1.90-3.63, P<0.001), improvement in cellular immunity(MD=0.63, 95% CI:0.45-0.80, P<0.0001), and reduction of VEGF(MD=-119.71, 95% CI:-135.75-103.68, P<0.0001), when compared with TACE group. The incidences of gastrointestinal reactions, myelosuppression, and liver dysfunction were similar between combination group and TACE group(P>0.05). However, compared to TACE, the combination of thalidomide and TACE had a higher incidence of drug rash(OR=6.35, 95% CI:2.75-14.68, P<0.0001).
  
  
  CONCLUSIONS
  Our findings suggest that thalidomide combined with TACE shows better clinical efficacy and tolerable adverse events in patients with primary HCC when compared with TACE alone.
authors.affiliation: Department of Oncology, RenMin Hospital of WuHan University, WuHan, Hubei, China.
authors.forename: De-Dong
authors.initials: DD
authors.lastname: Cao
authors.affiliation: Department of Oncology, The Fifth Hospital of WuHan, WuHan, Hubei, China.
authors.forename: Hui-Lin
authors.initials: HL
authors.lastname: Xu
authors.affiliation: Department of Oncology, Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Liu
authors.affiliation: Department of Oncology, RenMin Hospital of WuHan University, WuHan, Hubei, China.
authors.forename: Yong-Fa
authors.initials: YF
authors.lastname: Zheng
authors.affiliation: Department of Oncology, RenMin Hospital of WuHan University, WuHan, Hubei, China.
authors.forename: Si-Fa
authors.initials: SF
authors.lastname: Gao
authors.affiliation: Department of Oncology, RenMin Hospital of WuHan University, WuHan, Hubei, China.
authors.forename: Xi-Ming
authors.initials: XM
authors.lastname: Xu
authors.affiliation: Department of Oncology, RenMin Hospital of WuHan University, WuHan, Hubei, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Ge
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015415:Biomarkers; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods; D003131:Combined Modality Therapy; D006801:Humans; D007111:Immunity, Cellular; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D017594:Publication Bias; D011788:Quality of Life; D013792:Thalidomide / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D015415:Biomarkers; D013792:Thalidomide
keywords: TACE; hepatocellular carcinoma; meta-analysis; survival; thalidomide