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Abstract：
BACKGROUND: Hepatocellular carcinoma (HCC) ranks sixth globally in cancer incidence and third in mortality rates. Unfortunately, over 70% of HCC patients forego the opportunity for curative surgery or liver transplantation due to inadequate physical examinations, poor physical condition, and limited organ availability upon diagnosis. Clinical guidelines endorse transarterial chemoembolization (TACE) as the frontline treatment for intermediate to advanced-stage HCC. Cryoablation (CRA) is an emerging local ablative therapy increasingly used in HCC management. Recent studies suggest that combining CRA with TACE offers complementary and synergistic effects, potentially improving long-term survival rates. However, the superiority of combined TACE + CRA therapy over TACE alone for HCC lesions equal to or exceeding 5 cm requires further investigation.
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.
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.
摘要：
背景：肝细胞癌（HCC）在癌症发病率方面全球排名第六，死亡率排名第三。不幸的是,超过70％的肝癌患者放弃了治愈性手术或肝移植的机会，由于体检不足，身体状况差,诊断后器官的可用性有限。临床指南认可经动脉化疗栓塞（TACE）作为中晚期HCC的一线治疗。冷冻消融（CRA）是一种新兴的局部消融疗法，越来越多地用于HCC管理。最近的研究表明，CRA与TACE的结合提供了互补和协同作用，有可能提高长期生存率。然而,对于等于或超过5cm的HCC病变,TACE+CRA联合治疗比TACE单独治疗的优越性需要进一步研究.
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。
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。
