Korean Journal of Radiology

  • 제17권1호
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  • Pages.93-102
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  • 2016
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  • 1229-6929(pISSN)
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  • 2005-8330(eISSN)
대한영상의학회 (The Korean Society of Radiology)
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DOI QR코드

DOI QR Code

Efficacy and Safety of Radiofrequency Ablation Combined with Transcatheter Arterial Chemoembolization for Hepatocellular Carcinomas Compared with Radiofrequency Ablation Alone: A Time-to-Event Meta-Analysis

  • Wang, Xin (Department of Gastroenterology, First Affiliated Hospital of Xi'an Jiaotong University) ;
  • Hu, Yanan (Department of Gastroenterology, First Affiliated Hospital of Xi'an Jiaotong University) ;
  • Ren, Mudan (Department of Gastroenterology, First Affiliated Hospital of Xi'an Jiaotong University) ;
  • Lu, Xinlan (Department of Gastroenterology, First Affiliated Hospital of Xi'an Jiaotong University) ;
  • Lu, Guifang (Department of Gastroenterology, First Affiliated Hospital of Xi'an Jiaotong University) ;
  • He, Shuixiang (Department of Gastroenterology, First Affiliated Hospital of Xi'an Jiaotong University)
  • 투고 : 2015.03.15
  • 심사 : 2015.09.08
  • 발행 : 2016.02.01
⟨ 이전 논문 다음 논문 ⟩

초록

Objective: To compare the efficacy and safety of combined radiofrequency ablation (RFA) and transcatheter arterial chemoembolization (TACE) with RFA alone for hepatocellular carcinomas (HCC). Materials and Methods: Randomized controlled trial (RCT) studies that compared the clinical or oncologic outcomes of combination therapy of TACE and RFA versus RFA for the treatment of HCC were identified through literature searches of electronic databases (Pubmed, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure, and Google Scholar). Hazard ratios (HRs) or odds ratios (ORs) with their corresponding 95% confidence interval (CI) were combined as the effective value to assess the summary effects. The strength of evidence was rated by the Grading of Recommendations Assessment, Development, and Evaluation system. Results: Six RCTs with 534 patients were eligible for inclusion in this meta-analysis. The meta-analysis showed that the combination of TACE and RFA is associated with a significantly longer overall survival (HR = 0.62, 95% CI: 0.49-0.78, p < 0.001) and recurrence-free survival (HR = 0.55, 95% CI: 0.40-0.76, p < 0.001) in contrast with RFA monotherapy. The seemingly higher incidence of major complications in the combination group compared with RFA group did not reach statistical significance (OR = 1.17, 95% CI: 0.39-3.55, p = 0.78). Conclusion: In patients with HCC, the combination of TACE and RFA is associated with significantly higher overall survival and recurrence-free survival, as compared with RFA monotherapy, without significant difference in major complications.

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참고문헌

  1. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin 2015;65:87-108 https://doi.org/10.3322/caac.21262
  2. Sangiovanni A, Del Ninno E, Fasani P, De Fazio C, Ronchi G, Romeo R, et al. Increased survival of cirrhotic patients with a hepatocellular carcinoma detected during surveillance. Gastroenterology 2004;126:1005-1014 https://doi.org/10.1053/j.gastro.2003.12.049
  3. Shiina S, Teratani T, Obi S, Sato S, Tateishi R, Fujishima T, et al. A randomized controlled trial of radiofrequency ablation with ethanol injection for small hepatocellular carcinoma. Gastroenterology 2005;129:122-130 https://doi.org/10.1053/j.gastro.2005.04.009
  4. Lencioni R. Loco-regional treatment of hepatocellular carcinoma. Hepatology 2010;52:762-773 https://doi.org/10.1002/hep.23725
  5. N'Kontchou G, Mahamoudi A, Aout M, Ganne-Carrie N, Grando V, Coderc E, et al. Radiofrequency ablation of hepatocellular carcinoma: long-term results and prognostic factors in 235 Western patients with cirrhosis. Hepatology 2009;50:1475-1483 https://doi.org/10.1002/hep.23181
  6. Livraghi T, Goldberg SN, Lazzaroni S, Meloni F, Ierace T, Solbiati L, et al. Hepatocellular carcinoma: radiofrequency ablation of medium and large lesions. Radiology 2000;214:761-768 https://doi.org/10.1148/radiology.214.3.r00mr02761
  7. McGhana JP, Dodd GD 3rd. Radiofrequency ablation of the liver: current status. AJR Am J Roentgenol 2001;176:3-16 https://doi.org/10.2214/ajr.176.1.1760003
  8. Idee JM, Guiu B. Use of Lipiodol as a drug-delivery system for transcatheter arterial chemoembolization of hepatocellular carcinoma: a review. Crit Rev Oncol Hematol 2013;88:530-549 https://doi.org/10.1016/j.critrevonc.2013.07.003
  9. Maluccio MA, Covey AM, Porat LB, Schubert J, Brody LA, Sofocleous CT, et al. Transcatheter arterial embolization with only particles for the treatment of unresectable hepatocellular carcinoma. J Vasc Interv Radiol 2008;19:862-869 https://doi.org/10.1016/j.jvir.2008.02.013
  10. Min JH, Lee MW, Cha DI, Jeon YH, Shin SW, Cho SK, et al. Radiofrequency ablation combined with chemoembolization for intermediate-sized (3-5 cm) hepatocellular carcinomas under dual guidance of biplane fluoroscopy and ultrasonography. Korean J Radiol 2013;14:248-258 https://doi.org/10.3348/kjr.2013.14.2.248
  11. Takaki H, Yamakado K, Uraki J, Nakatsuka A, Fuke H, Yamamoto N, et al. Radiofrequency ablation combined with chemoembolization for the treatment of hepatocellular carcinomas larger than 5 cm. J Vasc Interv Radiol 2009;20:217-224 https://doi.org/10.1016/j.jvir.2008.10.019
  12. Chang NK, Shin SS, Kim JW, Kim HJ, Jeong YY, Heo SH, et al. Effect of ultrasound-guided radiofrequency ablation in incompletely treated hepatocellular carcinoma after transcatheter arterial chemoembolization. Korean J Radiol 2012;13 Suppl 1:S104-S111 https://doi.org/10.3348/kjr.2012.13.S1.S104
  13. Kim JW, Shin SS, Kim JK, Choi SK, Heo SH, Lim HS, et al. Radiofrequency ablation combined with transcatheter arterial chemoembolization for the treatment of single hepatocellular carcinoma of 2 to 5 cm in diameter: comparison with surgical resection. Korean J Radiol 2013;14:626-635 https://doi.org/10.3348/kjr.2013.14.4.626
  14. Hu YQ. Radiofrequency ablation and transcatheter arterial chemoembolization in primary hepatic carcinoma. Contemp Med 2011;17:39-40
  15. Tiong L, Maddern GJ. Systematic review and meta-analysis of survival and disease recurrence after radiofrequency ablation for hepatocellular carcinoma. Br J Surg 2011;98:1210-1224 https://doi.org/10.1002/bjs.7669
  16. Shibata T, Isoda H, Hirokawa Y, Arizono S, Shimada K, Togashi K. Small hepatocellular carcinoma: is radiofrequency ablation combined with transcatheter arterial chemoembolization more effective than radiofrequency ablation alone for treatment? Radiology 2009;252:905-913 https://doi.org/10.1148/radiol.2523081676
  17. Kang CB, Xu HB, Wang SL, Rui JA. Treatment of large hepatoma by TACE in combination with RFA. Zhonghua Gandan Waike Zazhi 2007;13:828-830
  18. Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011;343:d5928 https://doi.org/10.1136/bmj.d5928
  19. Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924-926 https://doi.org/10.1136/bmj.39489.470347.AD
  20. Parmar MK, Torri V, Stewart L. Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 1998;17:2815-2834 https://doi.org/10.1002/(SICI)1097-0258(19981230)17:24<2815::AID-SIM110>3.0.CO;2-8
  21. Tierney JF, Stewart LA, Ghersi D, Burdett S, Sydes MR. Practical methods for incorporating summary time-to-event data into meta-analysis. Trials 2007;8:16 https://doi.org/10.1186/1745-6215-8-16
  22. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2. The Cochrane Collaboration Web site. http://www.cochrane-handbook.org. Published September 2009
  23. Peng ZW, Zhang YJ, Chen MS, Xu L, Liang HH, Lin XJ, et al. Radiofrequency ablation with or without transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma: a prospective randomized trial. J Clin Oncol 2013;31:426-432
  24. Peng ZW, Zhang YJ, Liang HH, Lin XJ, Guo RP, Chen MS. Recurrent hepatocellular carcinoma treated with sequential transcatheter arterial chemoembolization and RF ablation versus RF ablation alone: a prospective randomized trial. Radiology 2012;262:689-700 https://doi.org/10.1148/radiol.11110637
  25. Morimoto M, Numata K, Kondou M, Nozaki A, Morita S, Tanaka K. Midterm outcomes in patients with intermediate-sized hepatocellular carcinoma: a randomized controlled trial for determining the efficacy of radiofrequency ablation combined with transcatheter arterial chemoembolization. Cancer 2010;116:5452-5460 https://doi.org/10.1002/cncr.25314
  26. Yang P, Liang M, Zhang Y, Shen B. Clinical application of a combination therapy of lentinan, multi-electrode RFA and TACE in HCC. Adv Ther 2008;25:787-794 https://doi.org/10.1007/s12325-008-0079-x
  27. Aikata H, Shirakawa H, Takaki S, Uka K, Miki D, Yamashina K, et al. Radiofrequency ablation combined with transcatheter arterial chemoembolization for small hepatocellular carcinomas. Hepatology 2006;44:494A
  28. Lin JJ, Wu W, Jiang XF, Jin XJ, Lu LJ, Bao LW. [Clinical outcomes of radiofrequency ablation combined with transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma: a single-center experience]. Zhonghua Zhong Liu Za Zhi 2013;35:144-147
  29. Cheng BQ, Jia CQ, Liu CT, Fan W, Wang QL, Zhang ZL, et al. Chemoembolization combined with radiofrequency ablation for patients with hepatocellular carcinoma larger than 3 cm: a randomized controlled trial. JAMA 2008;299:1669-1677 https://doi.org/10.1001/jama.299.14.1669
  30. Shen SQ, Xiang JJ, Xiong CL, Wu SM, Zhu SS. Intraoperative radiofrequency thermal ablation combined with portal vein infusion chemotherapy and transarterial chemoembolization for unresectable HCC. Hepatogastroenterology 2005;52:1403-1407
  31. Wang YB, Chen MH, Yan K, Yang W, Dai Y, Yin SS. [Quality of life of primary hepatocellular carcinoma patients after radiofrequency ablation]. Ai Zheng 2005;24:827-833
  32. Shibata T, Shibata T, Maetani Y, Isoda H, Hiraoka M. Radiofrequency ablation for small hepatocellular carcinoma: prospective comparison of internally cooled electrode and expandable electrode. Radiology 2006;238:346-353 https://doi.org/10.1148/radiol.2381041848
  33. Jiang G, Xu X, Ren S, Wang L. Combining transarterial chemoembolization with radiofrequency ablation for hepatocellular carcinoma. Tumour Biol 2014;35:3405-3408 https://doi.org/10.1007/s13277-013-1449-9
  34. Goldberg SN, Girnan GD, Lukyanov AN, Ahmed M, Monsky WL, Gazelle GS, et al. Percutaneous tumor ablation: increased necrosis with combined radio-frequency ablation and intravenous liposomal doxorubicin in a rat breast tumor model. Radiology 2002;222:797-804 https://doi.org/10.1148/radiol.2223010861
  35. Seki T, Tamai T, Nakagawa T, Imamura M, Nishimura A, Yamashiki N, et al. Combination therapy with transcatheter arterial chemoembolization and percutaneous microwave coagulation therapy for hepatocellular carcinoma. Cancer 2000;89:1245-1251 https://doi.org/10.1002/1097-0142(20000915)89:6<1245::AID-CNCR8>3.0.CO;2-F
  36. Ni JY, Liu SS, Xu LF, Sun HL, Chen YT. Meta-analysis of radiofrequency ablation in combination with transarterial chemoembolization for hepatocellular carcinoma. World J Gastroenterol 2013;19:3872-3882 https://doi.org/10.3748/wjg.v19.i24.3872
  37. Lu Z, Wen F, Guo Q, Liang H, Mao X, Sun H. Radiofrequency ablation plus chemoembolization versus radiofrequency ablation alone for hepatocellular carcinoma: a meta-analysis of randomized-controlled trials. Eur J Gastroenterol Hepatol 2013;25:187-194 https://doi.org/10.1097/MEG.0b013e32835a0a07
  38. Kong QF, Jiao JB, Chen QQ, Li L, Wang DG, Lv B. Comparative effectiveness of radiofrequency ablation with or without transarterial chemoembolization for hepatocellular carcinoma. Tumour Biol 2014;35:2655-2659 https://doi.org/10.1007/s13277-013-1349-z
  39. Yan S, Xu D, Sun B. Combination of radiofrequency ablation with transarterial chemoembolization for hepatocellular carcinoma: a meta-analysis. Dig Dis Sci 2012;57:3026-3031 https://doi.org/10.1007/s10620-012-2212-6
  40. Yan S, Xu D, Sun B. Combination of radiofrequency ablation with transarterial chemoembolization for hepatocellular carcinoma: a meta-analysis. Dig Dis Sci 2013;58:2107-2113 https://doi.org/10.1007/s10620-013-2570-8
  41. Wang W, Shi J, Xie WF. Transarterial chemoembolization in combination with percutaneous ablation therapy in unresectable hepatocellular carcinoma: a meta-analysis. Liver Int 2010;30:741-749 https://doi.org/10.1111/j.1478-3231.2010.02221.x
  42. Liu Z, Gao F, Yang G, Singh S, Lu M, Zhang T, et al. Combination of radiofrequency ablation with transarterial chemoembolization for hepatocellular carcinoma: an up-todate meta-analysis. Tumour Biol 2014;35:7407-7413 https://doi.org/10.1007/s13277-014-1976-z
  43. Spruance SL, Reid JE, Grace M, Samore M. Hazard ratio in clinical trials. Antimicrob Agents Chemother 2004;48:2787-2792 https://doi.org/10.1128/AAC.48.8.2787-2792.2004

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