Efficacy and Safety of TACE Combined with PSE for HCC Patients with Hypersplenism: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 LIUFeng ¹ , SUao-li ¹ , YUANBo ¹ , SHEYi ¹ ,  LIXiao ²

1. Department of General Practice, West China Hospital, Sichuan University, Chengdu 610041, China;
2. Department of Interventional, Cancer Hospital Chinese Academy of Medical Sciences, Beijing 100021, China;

Corresponding author：

LIXiao, Email: simonlixiao@263.net

Keywords：

Transcatheter arterial chemoembolization; Partial splenic embolization; Hepatocellular carcinoma; Hypersplenism; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20160087

Video：

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Objective To systematically evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with partial splenic embolization (PSE) for hepatocellular carcinoma (HCC) with hypersplenism. Method We searched The Cochrane Library (Issue 11, 2015), PubMed, EMbase, CBM, VIP, CNKI and WanFang Data databases from inception to November 1st 2015, to collect randomized controlled trials (RCTs) about TACE combined with PSE in treating HCC with hypersplenism. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies. Then meta-analysis was performed using RevMan 5.3 software. Results A total of 11 RCTs involving 708 patients were included. The results of meta-analysis showed that: Compared with TACE alone, TACE combined with PSE could significantly improve postoperative CD4 count (MD=6.99, 95%CI 4.60 to 9.38, P<0.00001), CD4/CD8 ratio (MD=0.64, 95% 0.45 to 0.84, P<0.00001), and the rate of half year survival (RR=1.16, 95%CI 1.02 to 1.32, P=0.02), decrease the incidences of spontaneous peritonitis (RR=0.20, 95%CI 0.05 to 0.48, P=0.03) and varices bleeding (RR=0.17, 95%CI 0.04 to 0.68, P=0.01). The two groups had similar incidence of post-embolization syndrome (RR=1.17, 95%CI 0.79 to 1.75, P=0.44). Conclusion TACE combined with PSE is more safe and effective than TACE alone in unresectable HCC with hypersplenism. Due to limited quantity and quality of the included studies, the above conclusion should be further verified by conducting more high quality, large scale RCTs.

Citation： LIUFeng, SUao-li, YUANBo, SHEYi, LIXiao. Efficacy and Safety of TACE Combined with PSE for HCC Patients with Hypersplenism: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2016, 16(5): 564-572. doi: 10.7507/1672-2531.20160087 Copy

1.	Korean Liver Cancer Study Group (KLCSG); National Cancer Center, Korea (NCC). 2014 KLCSG-NCC Korea Practice Guideline for the Management of Hepatocellular Carcinoma. Gut Liver, 2015, 9(3): 267-317.
2.	Wáng Y X, Baere T D,Idée J M, et al. Transcatheter embolization therapy in liver cancer:an update of clinical evidences. Chin J Cancer Res, 2015, 27(2): 96-121.
3.	高玉良, 郭都. PSE联合TACE治疗原发性肝癌合并脾功能亢进效果观察. 山东医药, 2009, 49(6): 105-106.
4.	徐晓翌, 刘合代, 黄骞, 等. 部分脾动脉栓塞在合并脾亢肝癌患者介入治疗中的临床观察. 浙江实用医学, 2011, 16(5): 329-330.
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6.	张金龙, 张军华, 韩萍, 等. 肝动脉化疗栓塞术联合功能性脾动脉血流栓塞术治疗原发性肝细胞癌合并脾功能亢进的临床观察. 中国综合临床, 2014, 30(12): 1309-1311.
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8.	于洪波, 李拥军,张卫华, 等. 原发性肝癌合并脾功能亢进33例行双栓塞治疗效果分析. 交通医学, 2011, 25(5): 503-505.
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10.	Huang J H, Gao F, Gu Y K, et al. Combined treatment of hepatocellular carcinoma with partial splenic embolization and transcatheter hepatic arterial chemoembolization. World J Gastroenterol, 2007, 13(28): 6593-6597.
11.	李桂芳, 谢松柏, 周有喜, 等. 肝动脉栓塞加部分脾栓塞治疗原发性肝癌伴脾亢的临床研究. 中国肿瘤临床, 1998, 25(1): 47-50.
12.	陶正龙, 程永德, 金洪先, 等. 原发性肝癌伴门脉高压的肝脾联合栓塞对肝功能的影响. 介入放射学杂志, 2004, 13(4): 328-330.
13.	章万勇, 查云飞. TACE联合部分脾栓塞术对肝癌患者免疫功能影响研究. 临床放射学杂志, 2015, 34(3): 451-454.
14.	Hadduck TA, McWilliams JP. Partial splenic artery embolization in cirrhotic patients. World J Radiol, 2014, 6(5):160-168.
15.	Koconis KG, Singh H. Partial splenic embolization in the treatment of patients with portal hypertension: a review of the english language literature. J Vasc Interv Radiol, 2007, 18(4): 463-481.
16.	Pålsson B, Hallén M, Forsberg AM, et al. Partial splenic embolization: long-term outcome. Langenbecks Arch Surg, 2003, 387(11-12): 421-426.
17.	Bruno S. Chemoembolization and radioembolization. Best Practice & Research Clinical Gastroenterology, 2014, 28(5): 909-919.
18.	Takayasu K, Shigeki A, Iwao I, et al. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology, 2006, 131(2): 51-53.
19.	Masafumi I, Yasuaki A, Park S J, et al. Prospective Study of Transcatheter Arterial Chemoembolization for Unresectable Hepatocellular Carcinoma: An Asian Cooperative Study between Japan and Korea-Journal of Vascular and Interventional Radiology. J Vasc Interv Radiol, 2013, 24(4): 490-500.
20.	Ooka Y, Chiba T, Ogasawara S, et al. Partial Splenic Embolization with Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma Accompanied by Thrombocytopenia. Biomed Res Int, 2014. 2014: 1-6.
21.	李小秋, 胡奎, 柴晓娜, 等. TACE及PSE联合治疗对肝癌患者肝功能及微循环状态的影响. 实用放射学杂志, 2003, 19(4): 349-351.

1. Korean Liver Cancer Study Group (KLCSG); National Cancer Center, Korea (NCC). 2014 KLCSG-NCC Korea Practice Guideline for the Management of Hepatocellular Carcinoma. Gut Liver, 2015, 9(3): 267-317.
2. Wáng Y X, Baere T D,Idée J M, et al. Transcatheter embolization therapy in liver cancer:an update of clinical evidences. Chin J Cancer Res, 2015, 27(2): 96-121.
3. 高玉良, 郭都. PSE联合TACE治疗原发性肝癌合并脾功能亢进效果观察. 山东医药, 2009, 49(6): 105-106.
4. 徐晓翌, 刘合代, 黄骞, 等. 部分脾动脉栓塞在合并脾亢肝癌患者介入治疗中的临床观察. 浙江实用医学, 2011, 16(5): 329-330.
5. 张永山, 潘光明. 肝癌伴脾功能亢进双介入治疗的临床研究. 吉林医学, 2011, 32(28): 5922-5923.
6. 张金龙, 张军华, 韩萍, 等. 肝动脉化疗栓塞术联合功能性脾动脉血流栓塞术治疗原发性肝细胞癌合并脾功能亢进的临床观察. 中国综合临床, 2014, 30(12): 1309-1311.
7. 李倩, 于友涛, 王晓伟,等. 肝动脉化疗栓塞术联合脾栓塞术治疗肝癌脾亢的临床应用价值. 标记免疫分析与临床, 2015, 22(8): 729-735.
8. 于洪波, 李拥军,张卫华, 等. 原发性肝癌合并脾功能亢进33例行双栓塞治疗效果分析. 交通医学, 2011, 25(5): 503-505.
9. Ishikawa T, Kubota T, Horigome R, et al. Concurrent partial splenic embolization with transcatheter arterial chemoembolization for hepatocellular carcinoma can maintain hepatic functional reserve. Hepatol Res, 2014. 44(11): 1056-1061.
10. Huang J H, Gao F, Gu Y K, et al. Combined treatment of hepatocellular carcinoma with partial splenic embolization and transcatheter hepatic arterial chemoembolization. World J Gastroenterol, 2007, 13(28): 6593-6597.
11. 李桂芳, 谢松柏, 周有喜, 等. 肝动脉栓塞加部分脾栓塞治疗原发性肝癌伴脾亢的临床研究. 中国肿瘤临床, 1998, 25(1): 47-50.
12. 陶正龙, 程永德, 金洪先, 等. 原发性肝癌伴门脉高压的肝脾联合栓塞对肝功能的影响. 介入放射学杂志, 2004, 13(4): 328-330.
13. 章万勇, 查云飞. TACE联合部分脾栓塞术对肝癌患者免疫功能影响研究. 临床放射学杂志, 2015, 34(3): 451-454.
14. Hadduck TA, McWilliams JP. Partial splenic artery embolization in cirrhotic patients. World J Radiol, 2014, 6(5):160-168.
15. Koconis KG, Singh H. Partial splenic embolization in the treatment of patients with portal hypertension: a review of the english language literature. J Vasc Interv Radiol, 2007, 18(4): 463-481.
16. Pålsson B, Hallén M, Forsberg AM, et al. Partial splenic embolization: long-term outcome. Langenbecks Arch Surg, 2003, 387(11-12): 421-426.
17. Bruno S. Chemoembolization and radioembolization. Best Practice & Research Clinical Gastroenterology, 2014, 28(5): 909-919.
18. Takayasu K, Shigeki A, Iwao I, et al. Prospective cohort study of transarterial chemoembolization for unresectable hepatocellular carcinoma in 8510 patients. Gastroenterology, 2006, 131(2): 51-53.
19. Masafumi I, Yasuaki A, Park S J, et al. Prospective Study of Transcatheter Arterial Chemoembolization for Unresectable Hepatocellular Carcinoma: An Asian Cooperative Study between Japan and Korea-Journal of Vascular and Interventional Radiology. J Vasc Interv Radiol, 2013, 24(4): 490-500.
20. Ooka Y, Chiba T, Ogasawara S, et al. Partial Splenic Embolization with Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma Accompanied by Thrombocytopenia. Biomed Res Int, 2014. 2014: 1-6.
21. 李小秋, 胡奎, 柴晓娜, 等. TACE及PSE联合治疗对肝癌患者肝功能及微循环状态的影响. 实用放射学杂志, 2003, 19(4): 349-351.

Chinese Journal of Evidence-Based Medicine

Efficacy and Safety of TACE Combined with PSE for HCC Patients with Hypersplenism: A Meta-analysis

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