Objective To evaluate the clinical effectiveness and safety of transcatheter arterial chemoembolization (TACE) combined with argon-helium cryotherapy system (AHCS) for primary hepatic carcinomas (PHC), and to provide references for clinical practice and research. Methods Such databases as The Cochrane Library, PubMed, EMbase, Web of Science, CBM, CNKI, VIP and WanFang Data were searched, and other sources like the relavant references were also retrieved to collect the randomized controlled trials (RCTs) about TACE combiend with AHCS for PHC published by May 1st, 2012. After literature screening, data extraction and quality evaluation performed by two reviewers independently according to the inclusion criteria, the meta-analysis was conducted using RevMan 5.1 software. Results A total of 16 RCTs involving 1 467 patients were included. The results of meta-analysis showed: a) The TACE+AHCS group was superior to the TACE alone group in total effective rate, complete necrosis rate, 0.5-, 1-, 1.5-, 2- and 2.5-year survival rates, AFP, CD4 and Th/Ts cells, and there were significant differences (Plt;0.05); and b) The TACE+AHCS group was superior to the AHCS alone group in 0.5-, 1.5-, 2- and 2.5-year survival rates, AFP and Th/Ts cells, and there were significant differences (Plt;0.05). Conclusion Compared with the TACE or AHCS alone, TACE combined with AHCS can improve long-term survival rate and short-term curative effect, and improve PHC patients’ immunity. However, its long-term curative effect and safety still needs to be further verified by more large sample and high quality RCTs.
Objective To evaluate the effectiveness and safety of traditional Chinese medicine (TCM) plus transcatheter arterial chemoembolization (TACE) compared with TACE alone, in the treatment of unresectable hepatocellular carcinoma (HCC). Methods The Cochrane Library, MEDLINE, EMBASE, CANCERLIT, CBM, CNKI and VIP were searched electronically. Relevant journals and conference proceedings were also handsearched. The quality of included studies was assessed according to the criteria recommended by the Cochrane Handbook for Systematic Reviews of Interventions, and meta-analyses were performed for homogeneous studies using The Cochrane Collaboration’s RevMan 4.2.10 software. Subgroup analyses by frequency of TACE (lt;3 or ≥3 times) were also performed. Results Thirty seven trials, all published in China, involving 2 653 participants were included. The quality of 2 studies was graded B (medium) and that of the other 35 was graded C (low). Meta-analyses showed that TCM plus TACE, compared with TACE alone, could significantly improve survival, tumor response (complete and partial), quality of life and clinical symptoms, and was also associated with a lower incidence of adverse reactions. Subgroup analyses indicated that, patients with less than three TACE had more significant improvement in survival and clinical symptoms, while patients with three or more TACE had more significant improvement in tumor response and quality of life. The incidence of adverse reactions was similar between these two different frequencies of TACE. Conclusions The treatment regimen of TCM plus TACE is superior to TACE alone in patients with unresectable HCC. As the existing data have a high risk of bias, the current evidence is insufficient to define the efficacy of the combination treatment, and further large-scale, high-quality randomized controlled trials are needed.
Objective To evaluate the clinical efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with thermotherapy for primary hepatic carcinoma (PHC), and to provide references for clinical practice and research. Methods The following databases as The Cochrane Library, PubMed, EMbase, CBM, CNKI, VIP and WanFang Data were searched electronically, and the other sources as supplying, such as tracing related references, were also retrieved. Besides, some unknown information was also obtained by communicating with other authors. All randomized controlled trials (RCTs) on TACE combined with thermotherapy versus TACE alone were collected. The literature was screened according to inclusive criteria, data were extracted and the quality of included studies was assessed, and then meta-analysis was conducted using RevMan 5.1 software. Results A total of 17 RCTs with 907 patients were included. Meta-analysis showed that compared with TACE alone, TACE combined with thermotherapy had a significant difference in 1-year survival rate (HR=2.40, 95%CI 1.65 to 3.48, Plt;0.000 01), 2-year survival rate (HR=3.28, 95%CI 1.87 to 5.76, Plt;0.000 1), total effective rate (RR=1.59, 95%CI 1.42 to 1.79, Plt;0.000 1) and improvement rate of life quality (RR=1.79, 95%CI 1.42 to 2.25, Plt;0.000 1). The incidences of myelosuppression and alimentary canal reactions were lower in TACE combined with thermotherapy group than those in TACE alone group, but statistically significance was only found in myelosuppression (RR=0.79, 95%CI 0.69 to 0.92, P=0.001). Conclusion Compared with TACE alone, TACE combined with thermotherapy can improve long-term survival rate and short-term curative effect, ameliorate the quality of life, and tend to reduce the incidence rate of side effects. But its long-term curative effect and more comprehensive safety still needs to be further verified by more large sample and high quality RCTs.
Objective To evaluate the impact of transcatheter arterial chemoembolization（TACE） on survival and tumor recurrence in patients with primary liver cancer， provide reference of clinical diagnosis and treatment for the primary liver cancer patients. Methods Two hundred and twenty-two cases of primary liver cancer were divided into TACE group （n=110） and control group （n=110）， TACE was performed after operation in the TACE group， convention treatment was performed after operation in the control group. The survival and tumor recurrence rates were compared between the TACE group and control group. Results The 1-， 2-， and 3-year survival rates were 83.64%， 56.36%，and 42.73% in the TACE group， respectively， which were 65.45%， 40.91%， and 21.82% in the control group，respectively. The differences were statistically significant （P＜0.05）. The 1-， 2-， and 3-year tumor recurrence rates were 20.91%， 54.55%， and 67.27% in the TACE group， respectively， which were 38.18%， 57.27%， and 70.91% in the control group， respectively. The 1-year tumor recurrence rate in the TACE group was significantly lower than that in the control group （P＜0.05）， but the differences of the 2- and 3-year recurrence rates were not statistically significant（P＞0.05）. Conclusions TACE treatment for primary liver cancer patients can increase long-term survival， but can’tdecrease long-term recurrence.
Objective To compare the effect of two chemotherapeutic patterns after hepatectomy of hepatocellular carcinoma （HCC） with portal vein tumor thrombi（PVTT）. Methods The clinical data of 51 HCC patients with PVTT who were treated in our department from June 2006 to December 2011 were analyzed retrospectively. Fifty-one HCC patients with PVTT who were performed hepatectomy and treatment of antivirus and improve immune were divided into two groups according to chemotherapeutic patterns after operation： portal vein infusion drug deliver system （PVIDDS）group （n=19） and transcatheter arterial chemoembolization（TACE） group（n=32），and to compare the treatment effect of the two groups. Results The recurrence rate of 1-month, 1-year，3-year， and 5-year after operation in TACE group was 3.1%（1/32），46.9%（15/32），84.4%（27/32）， and 100%（32/32），respectively. And in PVIDDS group, which was 5.3%（1/19），52.6%（10/19），100%（19/19）， and 100%（19/19），respectively. There were no differences in recurrence rate of 1-month, 1-year, and 5-year after operation in two groups（P＞0.05）. Recurrence rate of 3-year after operation in TACE group was lower than that in PVIDDS group（P＜0.05）. There were no differences in medial survival time（17.1 months vs.15.9 months）， survival rate of 1-year（93.8% vs.94.7%） and 3-year（40.6% vs. 36.8%） after operation in TACE group and PVIDDS group（P＞0.05）. Survival rate of 5-year after operation in TACE group was higher than that in PVIDDS group（21.9% vs.0, P＜0.05）. The rate of complication in TACE group was lower than that in PVIDDS group（65.6% vs.94.7%，P＜0.05）. Conclusions If the HCC patients with PVTT could endure operation，surgical resection should be considered firstly，furthermore antivirus treatment, improving immune，and chemotherapy should be considered after operation. The effect of TACE is better than PVIDDS.
ObjectiveTo explore the effect of hydroxyapatite nanoparticle (nHAP) on hepatocellular carcinoma (HCC) and its mechanisms. MethodsThe literatures about the effect of nHAP on HCC were reviewed and summarized. ResultsAs a new nanoparticle, nHAP could suppress the DNA synthesis and subsequent division and proliferation of HCC cells through the inhibition of proliferating cell nuclear antigen (PCNA) and telomerase gene expression and increase of intracellular Ca2+. Moreover, nHAP was able to suppress the differentiation and metastases of HCC cells through the effect on the expressions of Paxillin and P130cas and the decrease of expressions of multiple drug resistance gene protein, microvessel density, and vascular endothelial growth factor. Finally, nHAP induced the apoptosis of HCC tumor cells by the regulation of bcl-2 and bax protein expressions. The combined use of nHAP and chemoembolization drugs could enhance the efficacy, prolong drug duration and reduce toxicity. ConclusionnHAP can inhibit the division, proliferation, differentiation, and metastases, and promote the apoptosis of HCC cells and combined use with chemoembolization drugs can enhance the efficacy and reduce toxicity.
ObjectiveTo understand the latest progress of transcatheter arterial chemoembolization (TACE)-based combination therapies for unresectable liver metastasis from colorectal carcinoma, and to explore the safe and effective combination therapies in order to controlling the rapid progress of disease and improving the quality of life of patients. MethodsThe literatures about TACE-based combination therapies of liver metastasis from colorectal carcinoma and the latest advance in researches of this field at home and abroad were collected, and the application of combination therapies, the advantages and features of the combined treatments were reviewed. ResultsTACE was a safe and effective therapeutic modality in treating primary liver cancer or secondary liver cancer.Compared with a single treatment, TACE-based combination therapies had distinct advantages to patients with liver metastasis from colorectal carcinoma not only improved the quality of life but also prolonged the survival time.With the emerging of various kinds of new drugs and the rapid development of a variety of interventional treatments, it could bring long-term survival benifit for patients with liver metastasis from colorectal carcinoma. ConclusionsDoctors should pay attention to the combined treatments of patients with liver metastasis from colorectal carcinoma, improve the knowledge of personalized medication about advanced tumors and actively promote more usage of combination therapies.
ObjectiveTo systematically review the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with sorafenib and TACE only treating the intermediate or advanced hepatocellular carcinoma (HCC) in Chinese people. MethodsThe PubMed, Embase, Cochrane Library, CBM, CNKI, VIP, and Wanfang Data for randomized controlled trials (RCT) on TACE combined with sorafenib (TACE combined with sorafenib group) and TACE (TACE alone group) from inception to December 2014 were searched. The literatures and data were screened and extracted. The meta analysis was performed using RevMan 5.1 software. ResultsSix RCTs involving 498 patients with HCC were included. The results of meta analysis showed that the objective response rate[OR=2.28, 95% CI (1.52-3.42), P < 0.000 1] and the disease control rate[OR=6.62, 95% CI (4.12-10.65), P < 0.000 01] were higher, the 1-year survival rate[OR=3.27, 95% CI (2.06-5.22), P < 0.000 01] and 2-year survival rate[OR=4.55, 95% CI (2.28-9.07), P < 0.000 1] were longer, the safety and tolerability of adverse reactions were better in the TACE combined with sorafenib group as compared with the TACE alone group. ConclusionsIn Chinese people, compared with TACE alone group, TACE combined with sorafenib group have higher objective response rate, disease control rate, 1-year survival rate, and 2-year survival rate. However, due to the lower quality of included literatures, these conclusions should be treated cautiously.
ObjectiveTo investigate the significance of apparent diffusion coefficient (ADC value) for pretrea-tment prediction of short-term treatment effect in patients with hepatocellular carcinoma (HCC) who underwent transca-theter arterial chemoembolization (TACE). MethodsA total of twelve HCC patients with twenty-three HCC lesions who underwent TACE in our hospital from May. 2014 to May. 2015 were enrolled prospectively, to explore the difference between pre-and post-TACE in diameter of tumor, ADC value of HCC lesions, ADC value of liver parenchyma, and analyze the predictive significance of ADC value of HCC lesions for TACE in treatment of HCC. ResultsThere were no statistical difference between pre-and post-TACE in diameter of HCC lesions and ADC value of liver parenchyma (P=0.635, P=0.473), but the ADC value of HCC lesions was higher after TACE than pre-TACE (P=0.003). After TACE, the area of necrosis in HCC lesions was≥50% in 17 lesions (73.9%, good effect group), and <50% in 6 lesions (26.1%, poor effect group). Compared with poor effect group, ADC values of HCC lesions in good effect group were both higher before and after TACE (P<0.050). Area under ROC curve (AUC value) of ADC value in HCC lesions before TACE for predicting the effect of TACE was 0.690 (95% CI:0.510-0.879), with the sensitivity and specificity of 82.3% (95% CI:65.5%-93.2%) and 53.8% (95% CI:25.1%-80.8%) respectively, and the demarcation point for good effect and poor effect was 1.24×103 mm2/s. ConclusionThis preliminary study demonstrates that the ADC value of HCC lesions before TACE may be a useful indicator to predict early response of TACE in treatment of HCC.
ObjectiveTo evaluate therapeutical effects of Huaier granule combined with transcatheter arterial chemoembolization (TACE) following radical resection of primary hepatocellular carcinoma with microvascular invasion. MethodsThe clinical data of 45 cases of primary hepatocellular carcinoma with microvascular invasion underwent Huaier granule combined with transcatheter arterial chemoembolization (TACE) following radical resection from June 2010 to June 2013 in Liaoning Cancer Hospital were retrospectively analyzed. These patients were divided into Huaier granule plus TACE treatment group (20 cases) and simple TACE treatment group (25 cases) according to the postoperative treatment of the patients. The immune function (CD4+/CD8+ ratio and IL-2 level), 1and 3-year tumor recurrence rates and 3-year cumulative survival rate were compared between two groups after operation. Result① The CD4+/CD8+ ratio and IL-2 level had no significant differences between the 2 groups before operation (P > 0.05), which in the Huaier granule plus TACE treatment group were significantly higher than those in the simple TACE treatment group (P < 0.05) on month 3, 6, and 12 after operation.② 1and 3-year tumor recurrence rates in the Huaier granule plus TACE treatment group were significantly lower than those in the simple TACE treatment group[15% (3/20) versus 48% (12/25), P < 0.05; 45% (9/20) versus 80% (20/25), P < 0.05]. ③ The 3-year cumulative survival rate was 75% and 68% in the Huaier granule plus TACE treatment group and the simple TACE treatment group, respectively. The survival curve analysis showed that the 3-year survival rate had a decreased trend, which in the Huaier granule plus TACE treatment group was slightly higher than that in the simple TACE treatment group, but the difference had no statistical significance between the 2 groups (P > 0.05). ConclusionsAlthough the results of this study fails to confirm that Huaier granule plus TACE treatment for primary hepatocellular carcinoma with microvascular invasion following radical resection could significantly improve the 3-year cumulative survival rate, it could effectively decrease the recurrence rate. It is needed larger sample size to further explore in future research.