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      Transarterial chemoembolization versus hepatic resection in hepatocellular carcinoma treatment: a meta-analysis

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          Abstract

          Background

          A number of cohort studies have compared the outcomes of transarterial chemoembolization (TACE) and hepatic resection (HR) in the treatment of hepatocellular carcinoma (HCC). However, the effect of TACE versus HR remains controversial. Therefore, we conducted a meta-analysis to assess the effectiveness of TACE and HR in HCC treatment.

          Materials and methods

          PubMed, Embase, Web of Science, Scopus, ClinicalTrials.gov, and Cochrane library were searched from their inception until February 27, 2015 for relevant studies. The literature search was updated on May 25, 2015. Eligible studies were cohort studies comparing the survival outcomes between HCC patients undergoing TACE and HR. The primary outcome was overall survival (OS). Secondary outcomes were the recurrence rate and prognostic factors for OS. The risk ratio (RR) was used for the meta-analysis and was expressed with 95% confidence intervals (CIs).

          Results

          This meta-analysis included eleven cohort studies with 6,297 patients, all treated with TACE or HR. Pooled estimates showed that, compared with TACE, HR significantly improved the 3-year OS (RR =0.77; 95% CI, 0.63–0.93; P=0.009). TACE and HR had similar effects on OS after 1 year (RR =0.94; 95% CI, 0.86–1.01; P=0.103), 2 years (RR =0.50; 95% CI, 0.21–1.19; P=0.114), 4 years (RR =0.61; 95% CI, 0.58–1.10; P=0.174), and 5 years (RR =0.77; 95% CI, 0.59–1.01; P=0.06). There was no significant difference between the 3-year (RR =1.31; 95% CI, 0.65–2.64; P=0.457) and 5-year recurrence rates (RR =1.14; 95% CI, 0.69–1.89; P=0.597) in the TACE and HR groups. Age (>65 vs ≤65 years; hazard ratio =0.99; 95% CI, 0.98–1.00; P=0.000), sex (male vs female; hazard ratio =0.79; 95% CI, 0.65–0.96; P=0.02), treatment method (TACE vs HR; hazard ratio =1.90; 95% CI, 1.46–2.46; P=0.000), and Eastern Cooperative Oncology Group performance score (≥1 vs 0; hazard ratio =1.69; 95% CI, 1.22–2.33; P=0.002) were independent predictors for OS.

          Conclusion

          This meta-analysis suggests that the TACE and HR likely have similar effects in the treatment of HCC patients in terms of OS and recurrence rate. However, this conclusion should be interpreted cautiously due to the presence of further subgroup analyses with respect to outcomes in patients with different liver statuses (Barcelona Clinic Liver Cancer stage A or stage B).

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          Most cited references 23

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          Management of hepatocellular carcinoma.

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            Randomized controlled trial of screening for hepatocellular carcinoma.

            Screening for hepatocellular carcinoma (HCC) has been conducted for over 20 years, but there is no conclusive evidence that screening may reduce HCC mortality. The aim of this study was to assess the effect of screening on HCC mortality in people at increased risk. This study included 18,816 people, aged 35-59 years with hepatitis B virus infection or a history of chronic hepatitis in urban Shanghai, China. Participants were randomly allocated to a screening (9,373) or control (9,443) group. Controls received no screening and continued to use health-care facilities. Screening group participants were invited to have an AFP test and ultrasonography examination every 6 months. Screening was stopped in December 1997; by that time screening group participants had been offered five to ten times. All participants were followed up until December 1998. The primary outcome measure was HCC mortality. The screened group completed 58.2 percent of the screening offered. When the screening group was compared to the control group, the number of HCC was 86 versus 67; subclinical HCC being 52 (60.5%) versus 0; small HCC 39 (45.3%) versus 0; resection achieved 40 (46.5%) versus 5 (7.5%); 1-, 3,-, and 5-year survival rate 65.9%, 52.6%, 46.4% versus 31.2%, 7.2%, 0, respectively. Thirty-two people died from HCC in the screened group versus 54 in the control group, and the HCC mortality rate was significantly lower in the screened group than in controls, being 83.2/100,000 and 131.5/100,000, respectively, with a mortality rate ratio of 0.63 (95%CI 0.41-0.98). Our finding indicated that biannual screening reduced HCC mortality by 37%.
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              Hepatocellular carcinoma: an epidemiologic view.

              Hepatocellular carcinoma (HCC) is the fifth most common malignancy in the world and is estimated to cause approximately half a million deaths annually. Because of its high fatality rates, the incidence and mortality rates are almost equal. The major risk factors for HCC are chronic hepatitis B virus infection, chronic hepatitis C virus (HCV) infection, and alcoholic cirrhosis. The epidemiology of HCC is characterized by marked demographic (age, gender, race/ethnicity) and geographic variations. Hepatitis B virus infection, with and without aflatoxin exposure, is responsible for most cases in developing countries; better control of these risk factors has resulted in a recent decline in HCC in some places like Taiwan and China. Recently, however, a trend of rising rates of HCC has been reported from several developed countries in Europe and North America. These new trends are associated with "new" risk factors such as HCV and, possibly, diabetes. In the United States, the incidence of HCC has approximately doubled over the past 3 decades. White individuals are two to three times less often affected than African Americans, who in turn are two to three times less often affected than Asians, Pacific Islanders, or Native Americans. Men are two to three times more often affected than women. Concomitant with the rising rates of HCC, there has been a shift of incidence from typically elderly patients to relatively younger patients between ages of 40 to 60 years. An increase in HCV-related HCC accounts for at least half of the witnessed increase in HCC in the United States. Hepatocellular carcinoma continues to carry an overall dismal survival rate (close to 5%); very few patients qualify for and receive potentially curative therapy. The future incidence trends of HCC will be determined to a large extent by the clinical course of HCV-infected people.
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                Author and article information

                Journal
                Drug Des Devel Ther
                Drug Des Devel Ther
                Drug Design, Development and Therapy
                Drug Design, Development and Therapy
                Dove Medical Press
                1177-8881
                2015
                10 August 2015
                : 9
                : 4431-4440
                Affiliations
                [1 ]Molecular Oncology Laboratory of Cancer Research Institute, The First Affiliated Hospital of China Medical University, Shenyang, People’s Republic of China
                [2 ]Health and Family Planning Commission of Liaoning Province, People’s Republic of China
                Author notes
                Correspondence: You-hong Jiang, Molecular Oncology Laboratory of Cancer Research Institute, the First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Heping district, Shenyang 110001, People’s Republic of China, Tel +86 24 8328 2354, Fax +86 24 8328 2473, Email youhongj19@ 123456hotmail.com
                Article
                dddt-9-4431
                10.2147/DDDT.S86629
                4539084
                © 2015 Tian et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License

                The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Original Research

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