OBJECTIVE: To compare the efficacy and safety of TACE combined with CRA vs TACE alone in the treatment of HCC with a diameter of ≥ 5 cm.
METHODS: PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and VIP databases were searched to retrieve all relevant studies on TACE and CRA up to July 2022. Meta-analysis was performed using RevMan 5.3 software.
RESULTS: After screening according to the inclusion and exclusion criteria, 6 articles were included, including 2 randomized controlled trials and 4 nonrandomized controlled trials, with a total of 575 patients included in the meta-analysis. The results showed that the objective response rate [odds ratio (OR) = 2.56, 95% confidence interval (CI):1.66-3.96, P < 0.0001), disease control rate (OR = 3.03, 95%CI: 1.88-4.89, P < 0.00001), 1-year survival rate (OR = 3.79, 95%CI: 2.50-5.76, P < 0.00001), 2-year survival rate (OR = 2.34, 95%CI: 1.43-3.85, P = 0.0008), and 3-year survival rate (OR = 3.34, 95%CI: 1.61-6.94, P = 0.001) were all superior to those of the control group; the postoperative decrease in alpha-fetoprotein value (OR = 295.53, 95%CI: 250.22-340.85, P < 0.0001), the postoperative increase in CD4 value (OR = 10.59, 95%CI: 8.78-12.40, P < 0.00001), and the postoperative decrease in CD8 value (OR = 6.47, 95%CI: 4.44-8.50, P < 0.00001) were also significantly higher than those in the TACE-alone treatment group.
CONCLUSIONS: Compared with TACE-alone treatment, TACE + CRA combined treatment not only improves the immune function of HCC patients with a diameter of ≥ 5 cm, but also enhances the therapeutic efficacy and long-term survival rate, without increasing the risk of complications. Therefore, TACE + CRA combined treatment may be a more recommended treatment for patients with HCC with a diameter of ≥ 5 cm.
目的:比较TACE联合CRA与单纯TACE治疗直径≥5cmHCC的疗效和安全性。
方法:PubMed,EMBASE,科克伦图书馆,CNKI,万方,和VIP数据库进行检索,以检索截至2022年7月所有关于TACE和CRA的相关研究。采用RevMan5.3软件进行Meta分析。
结果:根据纳入和排除标准进行筛选后,包括6篇文章,包括2项随机对照试验和4项非随机对照试验,共有575例患者纳入荟萃分析.结果表明,客观反应率[优势比(OR)=2.56,95%置信区间(CI):1.66-3.96,P<0.0001),疾病控制率(OR=3.03,95CI:1.88-4.89,P<0.00001),1年生存率(OR=3.79,95CI:2.50-5.76,P<0.00001),2年生存率(OR=2.34,95CI:1.43-3.85,P=0.0008),3年生存率(OR=3.34,95CI:1.61~6.94,P=0.001)均优于对照组;术后甲胎蛋白值降低(OR=295.53,95CI:250.22~340.85,P<0.0001),术后CD4值升高(OR=10.59,95CI:8.78~12.40,P<0.00001),术后CD8值下降(OR=6.47,95CI:4.44~8.50,P<0.00001)也明显高于单纯TACE治疗组。
结论:与单纯TACE治疗相比,TACE+CRA联合治疗不仅能改善直径≥5cm的HCC患者的免疫功能,而且还提高了治疗效果和长期生存率,不会增加并发症的风险。因此,对于直径≥5cm的HCC患者,TACE+CRA联合治疗可能是更推荐的治疗方法。