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Comparison of surgery resection, transcatheter arterial chemoembolization and local ablation for primary large hepatocellular carcinoma: A systematic review and meta-analysis
  • +3
  • luke Zhou,
  • Jian Chen,
  • Hui Xie,
  • Jie Yang,
  • Lin Liu,
  • Yi Li
luke Zhou

Corresponding Author:[email protected]

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Objectives: To determine surgery resection (SR), the use of transcatheter arterial chemoembolization (TACE) and the use of local ablation, which is more effective for patients with primary large hepatocellular carcinoma (HCC). Methods: We assessed clinical trials through PubMed, Medline, Embase and the Cochrane Library up to March 2020. The basic data and the overall survival (OS) were recorded. The primary outcome was short-term and long-term survival. Results: A total of 23 researches including 2849 patients were enrolled in the meta-analysis. The meta-analysis indicated a significant improvement in the 1-year OS (HR=2.71, 95% CI 1.75–4.22, P < 0.01), 2-year OS (HR = 2.51, 95% CI 1.59–3.96, P < 0.01) favoring combination therapy over monotherapy. A significant improvement in the 1-year (HR = 3.38, 95% CI 1.90–6.01, P <0.01) and 2-year (HR = 1.96, 95% CI 1.25–3.07, P =0.003) OS favoring TACE + SR over TACE therapy. The pooled outcome indicated that three-year OS rate (HR = 3.11, 95% CI 1.49–6.49, P =0.002) and 5-year OS (HR = 2.95, 95% CI 1.30–6.66, P =0.009) was higher in the SR group than in the TACE group. Meta-analysis indicated that TACE+ ablation therapy was superior to other therapy (P<0.01) except when compared with TACE+SR/ SR (P>0.01). Conclusions: In patients with large hepatocellular carcinoma, SR is the preferred treatment. For those patients who cannot be operated or lack of surgical opportunity, TACE combined with local ablation therapy may achieve better therapeutic effect.