Abstract
BackgroundTo compare the efficacy of three types of palliative therapy for advanced hepatocellular carcinoma (HCC), including transarterial chemoembolisation (TACE) monotherapy, sorafenib alone and their combination.MethodsThe databases of PubMed, Embase and Cochrane Library were retrieved. The odds ratio (OR) with its 95% confidence interval (CI) was used to investigate the binary variables, and the standardised mean difference (SMD) with its 95% CI was employed to evaluate the continuous variables. All statistical tests were performed by using Stata/SE, version 12.0.ResultsThirty-one clinical studies, containing 5125 unique cases of patients with advanced HCC, were included. There were significant improvements in overall survival (OS) (pooled SMD = 2.54; 95% CI 1.74–3.34) and time to progression (TTP) (pooled SMD = 2.49; 95% CI 0.87–4.12) of the patients after receiving the combination therapy of TACE and sorafenib, compared to TACE monotherapy, and the OS in the combined treatment cohort was also longer than that in the sorafenib-alone cohort (pooled SMD = 2.92; 95% CI 1.72–4.13). The combination therapy group in comparison to the TACE group benefited a significantly increased overall response rate (ORR) (pooled OR = 2.61; 95% CI 1.43–4.77), 1-year (pooled OR = 2.96; 95% CI 1.71–5.14) and 2-year (pooled OR = 1.64; 95% CI 1.18–2.28) survival rates and reduced disease progression rate (DPR) (pooled OR = 0.47; 95% CI 0.33–0.68); in parallel, the ORR in the group was also significantly higher than that in the sorafenib-alone group (pooled OR = 3.62; 95% CI 1.28–10.22), although without a difference in the DPR (pooled OR = 0.28; 95% CI 0.05–1.48). In addition, we discovered that the 1-year (pooled OR = 1.39; 95% CI 0.84–2.29) and 2-year (pooled OR = 1.70; 95% CI 0.69–4.18) survival rates in the TACE monotherapy cohort were not significantly different to those in the sorafenib-alone cohort.ConclusionThe combination therapy is more effective than monotherapy in improving the prognostic outcomes of patients with advanced HCC. Therefore, we recommend it as the preferred treatment intervention for those patients.
Highlights
To compare the efficacy of three types of palliative therapy for advanced hepatocellular carcinoma (HCC), including transarterial chemoembolisation (TACE) monotherapy, sorafenib alone and their combination
The combination therapy is more effective than monotherapy in improving the prognostic outcomes of patients with advanced HCC
After the removal of duplicate citations (N = 269) and those types of work classified as review (N = 75), case report (N = 24) and conference paper (N = 465), 599 records were qualified for title and abstract screening; 211 of them were excluded by this process, leaving 59 articles for full-text evaluation
Summary
To compare the efficacy of three types of palliative therapy for advanced hepatocellular carcinoma (HCC), including transarterial chemoembolisation (TACE) monotherapy, sorafenib alone and their combination. The most effective way to treat a tumour in HCC is surgically, but only less than 18% of patients undergo it [3]; many patients are deprived of the surgery opportunity when they are initially diagnosed with an advanced-stage disease. For patients with Barcelona Clinic Liver Cancer (BCLC) stage B or C HCC who are not eligible for surgery [4], it is recommended to receive transarterial chemoembolisation (TACE) or sorafenib as the treatment modality. Considering that sorafenib can inhibit VEGF signalling, it may be effective to reduce TACE-induced overproduction of VEGF, further ameliorating the disease control of advanced HCC after TACE. The results of many studies have indicated that patients with this carcinoma derived more survival benefits from the combination of sorafenib and TACE than from TACE alone [12,13,14]
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