OPTIMAL TREATMENT STRATEGIES FOR HEPATOCELLULAR CARCINOMA: A META-ANALYSIS COMPARING TRANSARTERIAL CHEMOEMBOLIZATION (TACE) PLUS MICROWAVE ABLATION (MWA) VERSUS MICROWAVE ABLATION ALONE

Document Type

Conference Proceeding

Publication Date

10-9-2024

Publication Title

Hepatology

Abstract

Background: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths, with a rising incidence due to non-alcoholic steatohepatitis. Microwave ablation (MWA) is the preferred thermal ablation technique for its larger, more homogeneous ablation zones. Combining transarterial chemoembolization (TACE) with MWA enhances treatment efficacy by reducing heat-sink effects and delivering cytotoxic drugs to microscopic HCCs. This is the first metaanalysis comparing the efficacy of TACE plus MWA versus MWA alone in HCC patients, aiming to optimize treatment strategies for HCC. Methods: This metaanalysis adhered to Cochrane guidelines and PRISMA standards, comparing the effectiveness of TACE plus MWA versus MWA alone for HCC treatment. A comprehensive search was conducted across PubMed, MEDLINE, Embase, Scopus, and CENTRAL databases until May 2024. Inclusion criteria targeted RCTs and observational studies with adult HCC patients receiving TACE plus MWA or MWA alone. Data extraction followed PICOS criteria and was performed using Excel. Statistical analyses utilized RevMan with a random-effects model, considering results significant at p < 0.05. Results: Of 485 screened studies, seven studies with 971 HCC patients were included. The TACE plus MWA group had 352 patients, and the MWA group had 619. Primary outcomes assessed included primary effectiveness, overall survival rates, and recurrence/ progression-free survival rates. Primary effectiveness showed no significant improvement (OR: 1.80; 95% CI: 0.88, 3.66). One-year overall survival (OR: 1.14; 95% CI: 0.55, 2.35), three-year overall survival (OR: 0.93; 95% CI: 0.54, 1.59), and five-year overall survival (OR: 0.58; 95% CI: 0.28, 1.21) showed no significant differences. Recurrence/progression-free survival at one year (OR: 1.18; 95% CI: 0.73, 1.92) and three years (OR: 2.09; 95% CI: 0.63, 6.89) also showed no significant differences. Secondary outcomes included disease progression/recurrence (OR: 0.67; 95% CI: 0.43, 1.05) and mean survival time (MD: -4.33 months; 95% CI: -16.07, 8.04), both of which were not significantly different. Adverse events, including intra-abdominal bleeding (OR: 0.72; 95% CI: 0.25, 2.11), GI symptoms (OR: 1.54; 95% CI: 0.21, 11.08), overall adverse events (OR: 2.56; 95% CI: 0.24, 26.79), and fever (OR: 3.65; 95% CI: 0.88, 15.20), showed no significant differences. Conclusion: This meta-analysis shows that combining TACE with MWA does not significantly improve primary effectiveness, overall survival, or recurrence/progression-free survival rates compared to MWA alone in treating HCC. Both treatments have similar safety profiles. Future research should identify subpopulations that may benefit from combined therapy, conduct larger randomized controlled trials, and assess the impact of transarterial radioembolization (TARE) with ablation, given the increasing use of radiation-based HCC treatments in the US.

Volume

80

First Page

S1496

Last Page

S1497

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