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Hepatology Research : the Official... Oct 2014Des-gamma-carboxy prothrombin (DCP) and α-fetoprotein (AFP) are useful tumor markers for the detection of hepatocellular carcinoma (HCC). However, it remains...
AIMS
Des-gamma-carboxy prothrombin (DCP) and α-fetoprotein (AFP) are useful tumor markers for the detection of hepatocellular carcinoma (HCC). However, it remains controversial whether the diagnostic accuracy of DCP is superior to AFP. The aims of this review were to compare the diagnostic accuracy of DCP, AFP and combination of both markers for detecting HCC and further compare their accuracy in diagnosing early stage HCC.
METHODS
We conducted a comprehensive literature search of MEDLINE, EMBASE and Cochrane library until April 2013. Two authors independently assessed the methodological quality of each included study. Summary estimates of sensitivity, specificity and area under the receiver operating curve (AUROC) were calculated.
RESULTS
Forty-nine studies involving 14 118 participants (including 1544 with early stage HCC) were included. In case of detection of HCC, the summary estimates of DCP were: sensitivity 63% (95% confidence interval [CI], 58%-67%), specificity 91% (95% CI, 88%-93%), and the values of AFP were: sensitivity 59% (95% CI, 54%-63%), specificity 86% (95% CI, 82%-89%). The AUROC of DCP, AFP and combination of both markers were 0.83, 0.77 and 0.88, respectively. Among the early stage HCC, the summary estimates of DCP and AFP were: sensitivity 45% (95% CI, 35%-57%) versus 48% (95% CI, 39%-57%), and specificity 95% (95% CI, 91%-97%) versus 89% (95% CI, 79%-95%). The AUROC was 0.84 for DCP, 0.68 for AFP and 0.83 for the combination of both markers.
CONCLUSION
Des-gamma-carboxy prothrombin shows more diagnostic accuracy than AFP, especially in diagnosing early stage HCC, and the combination of both markers cannot improve the diagnostic accuracy of early stage HCC.
PubMed: 23834468
DOI: 10.1111/hepr.12201 -
The Cochrane Database of Systematic... Nov 2015Down's syndrome occurs when a person has three, rather than two copies of chromosome 21; or the specific area of chromosome 21 implicated in causing Down's syndrome. It... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Down's syndrome occurs when a person has three, rather than two copies of chromosome 21; or the specific area of chromosome 21 implicated in causing Down's syndrome. It is the commonest congenital cause of mental disability and also leads to numerous metabolic and structural problems. It can be life-threatening, or lead to considerable ill health, although some individuals have only mild problems and can lead relatively normal lives. Having a baby with Down's syndrome is likely to have a significant impact on family life.Noninvasive screening based on biochemical analysis of maternal serum or urine, or fetal ultrasound measurements, allows estimates of the risk of a pregnancy being affected and provides information to guide decisions about definitive testing. However, no test can predict the severity of problems a person with Down's syndrome will have.
OBJECTIVES
The aim of this review was to estimate and compare the accuracy of first trimester serum markers for the detection of Down's syndrome in the antenatal period, both as individual markers and as combinations of markers. Accuracy is described by the proportion of fetuses with Down's syndrome detected by screening before birth (sensitivity or detection rate) and the proportion of women with a low risk (normal) screening test result who subsequently had a baby unaffected by Down's syndrome (specificity).
SEARCH METHODS
We conducted a sensitive and comprehensive literature search of MEDLINE (1980 to 25 August 2011), Embase (1980 to 25 August 2011), BIOSIS via EDINA (1985 to 25 August 2011), CINAHL via OVID (1982 to 25 August 2011), The Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 25 August 2011), MEDION (25 August 2011), The Database of Systematic Reviews and Meta-Analyses in Laboratory Medicine (25 August 2011), The National Research Register (Archived 2007), Health Services Research Projects in Progress database (25 August 2011). We did forward citation searching ISI citation indices, Google Scholar and PubMed 'related articles'. We did not apply a diagnostic test search filter. We also searched reference lists and published review articles.
SELECTION CRITERIA
We included studies in which all women from a given population had one or more index test(s) compared to a reference standard (either chromosomal verification or macroscopic postnatal inspection). Both consecutive series and diagnostic case-control study designs were included. Randomised trials where individuals were randomised to different screening strategies and all verified using a reference standard were also eligible for inclusion. Studies in which test strategies were compared head-to-head either in the same women, or between randomised groups were identified for inclusion in separate comparisons of test strategies. We excluded studies if they included less than five Down's syndrome cases, or more than 20% of participants were not followed up.
DATA COLLECTION AND ANALYSIS
We extracted data as test positive or test negative results for Down's and non-Down's pregnancies allowing estimation of detection rates (sensitivity) and false positive rates (1-specificity). We performed quality assessment according to QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criteria. We used hierarchical summary ROC meta-analytical methods or random-effects logistic regression methods to analyse test performance and compare test accuracy as appropriate. Analyses of studies allowing direct and indirect comparisons between tests were undertaken.
MAIN RESULTS
We included 56 studies (reported in 68 publications) involving 204,759 pregnancies (including 2113 with Down's syndrome). Studies were generally of good quality, although differential verification was common with invasive testing of only high-risk pregnancies. We evaluated 78 test combinations formed from combinations of 18 different tests, with or without maternal age; ADAM12 (a disintegrin and metalloprotease), AFP (alpha-fetoprotein), inhibin, PAPP-A (pregnancy-associated plasma protein A, ITA (invasive trophoblast antigen), free βhCG (beta human chorionic gonadotrophin), PlGF (placental growth factor), SP1 (Schwangerschafts protein 1), total hCG, progesterone, uE3 (unconjugated oestriol), GHBP (growth hormone binding protein), PGH (placental growth hormone), hyperglycosylated hCG, ProMBP (proform of eosinophil major basic protein), hPL (human placental lactogen), (free αhCG, and free ßhCG to AFP ratio. Direct comparisons between two or more tests were made in 27 studies.Meta-analysis of the nine best performing or frequently evaluated test combinations showed that a test strategy involving maternal age and a double marker combination of PAPP-A and free ßhCG significantly outperformed the individual markers (with or without maternal age) detecting about seven out of every 10 Down's syndrome pregnancies at a 5% false positive rate (FPR). Limited evidence suggested that marker combinations involving PAPP-A may be more sensitive than those without PAPP-A.
AUTHORS' CONCLUSIONS
Tests involving two markers in combination with maternal age, specifically PAPP-A, free βhCG and maternal age are significantly better than those involving single markers with and without age. They detect seven out of 10 Down's affected pregnancies for a fixed 5% FPR. The addition of further markers (triple tests) has not been shown to be statistically superior; the studies included are small with limited power to detect a difference.The screening blood tests themselves have no adverse effects for the woman, over and above the risks of a routine blood test. However some women who have a 'high risk' screening test result, and are given amniocentesis or chorionic villus sampling (CVS) have a risk of miscarrying a baby unaffected by Down's. Parents will need to weigh up this risk when deciding whether or not to have an amniocentesis or CVS following a 'high risk' screening test result.
Topics: ADAM Proteins; ADAM12 Protein; Biomarkers; Chorionic Gonadotropin, beta Subunit, Human; Down Syndrome; Female; Humans; Maternal Age; Membrane Proteins; Predictive Value of Tests; Pregnancy; Pregnancy Trimester, First; Pregnancy-Associated Plasma Protein-A; Prenatal Diagnosis; alpha-Fetoproteins
PubMed: 26617074
DOI: 10.1002/14651858.CD011975 -
World Journal of Surgery May 2015Hepatocellular carcinoma (HCC) typically recurs following primary treatment. The primary objective of this systematic review was to evaluate the safety and efficacy of... (Review)
Review
BACKGROUND
Hepatocellular carcinoma (HCC) typically recurs following primary treatment. The primary objective of this systematic review was to evaluate the safety and efficacy of ablative therapies for recurrent HCC. The secondary objective was to identify any factors associated with prognosis following ablation for recurrent disease.
METHODS
A systematic search of the literature published between January 2000 and December 2013 was undertaken using the PubMed, Medline and Scopus databases. Reference lists from selected studies were manually searched to ensure complete capture of any relevant data.
RESULTS
A total of 19 studies were included in the review. The median age of patients undergoing ablation for recurrent HCC was 58 years (range 52-69 years) and 85 % of patients had cirrhosis (range 56-100 %). HCC recurred as a single nodule in 79 % of those treated with ablation (range 46-100 %). There were few significant complications associated with any form of ablation. Sufficient data were only available to allow analysis of survival outcomes following radiofrequency ablation (RFA). After RFA the median, 1, 3 and 5-year survivals were 84 % (73-99 %), 51 % (42-84 %) and 40 % (28-83 %), respectively. The only factor consistently associated with overall survival following ablation for recurrence was the alpha-fetoprotein (AFP) level.
CONCLUSION
Comparable survival figures from previously published systematic reviews suggest that hepatic resection is the most effective treatment for recurrent HCC. However, ablation can be a safe and effective option for the majority of patients with recurrent disease who are unsuitable for surgery. Elevated levels of AFP suggest a poorer prognosis following ablation.
Topics: Ablation Techniques; Aged; Carcinoma, Hepatocellular; Catheter Ablation; Humans; Liver Neoplasms; Middle Aged; Neoplasm Recurrence, Local; Prognosis; Survival Rate; alpha-Fetoproteins
PubMed: 25634340
DOI: 10.1007/s00268-015-2956-1 -
Transplantation Reviews (Orlando, Fla.) Jan 2022Data on predictors of post-recurrence survival (PRS) of recurrent hepatocellular carcinoma (HCC) after liver transplantation (LT) have not been reviewed and analysed... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Data on predictors of post-recurrence survival (PRS) of recurrent hepatocellular carcinoma (HCC) after liver transplantation (LT) have not been reviewed and analysed systematically. We aimed to systematically analyse all published data on the predictors for PRS.
METHODS
In accordance with PRISMA and MOOSE guidelines, online search of PubMed and EMBASE databases was done for all reports that evaluate the predictors of PRS based on multivariate analyses. Cumulative analyses of hazard ratios (HRs) and their corresponding 95% CIs were conducted to assess the potential predictors of PRS.
RESULTS
Twenty-three studies met the inclusion criteria. Among the 11,868 patients involved, 1921 (16%) had HCC recurrence within a median time of 16 months. The following were recurrence and tumour-related predictors: time to recurrence (<1 year; HR: 1.97; p < 0.001), AFP level at recurrence(≥100 ng/ml; HR: 1.82; p < 0.001), multiple recurrence (HR: 1.22; p < 0.001), bone recurrence (HR: 2.10; p < 0.001), poor differentiation (HR: 1.52; p < 0.001), intrahepatic recurrence (HR: 0.91; p = 0.03), extrahepatic recurrence (HR: 1.87; p < 0.001), Milan criteria at LT (HR: 1.34; p < 0.001), microvascular invasion (HR: 1.59; p < 0.001), multiorgan recurrence (HR: 1.28; p < 0.001), and recurrent HCV infection (HR: 1.21; p < 0.001). The treatment-related predictors were as follows: surgical resection (HR: 0.33; p < 0.001), mTOR inhibitors (HR: 0.63; p < 0.001), sorafenib (HR: 1.00; p = 0.01), palliative treatment (HR: 3.07; p < 0.001), RFA (HR: 0.47; p < 0.001), and radiotherapy (HR: 1.19; p < 0.001).
CONCLUSIONS
Systematic evaluation of these predictors could guide surgeons to design risk-adapted algorithms for the management of post-LT HCC recurrence to construct reliable predictive models and to design future prospective studies or clinical trials.
Topics: Carcinoma, Hepatocellular; Humans; Liver Neoplasms; Liver Transplantation; Neoplasm Recurrence, Local; Prospective Studies; Retrospective Studies; Risk Factors; alpha-Fetoproteins
PubMed: 34999555
DOI: 10.1016/j.trre.2021.100676 -
European Journal of Obstetrics,... Jul 2020In women with twin pregnancies biomarkers are not used to predict preterm birth in clinical practice. This systematic review assessed the risk of both spontaneous and... (Meta-Analysis)
Meta-Analysis Review
In women with twin pregnancies biomarkers are not used to predict preterm birth in clinical practice. This systematic review assessed the risk of both spontaneous and iatrogenic preterm birth in twin pregnancies based on biochemical predictors. We searched the electronic databases from January 1990 to June 2019 without language restrictions. All studies on twin pregnancies where biochemical predictors and preterm birth were evaluated were included. We reported our findings as odds ratio (OR) with 95 % confidence intervals (CI) and pooled the estimates using random-effects meta-analysis for various predictor thresholds. From 12,623 citations, we included 33 studies involving 6077 pregnancies. The odds of preterm birth <28 weeks (OR 12.06, 95 % CI 4.90-29.70, I = 0%), <32 weeks (OR 10.03, 95 % CI 6.11-16.47, I = 0%), <34 weeks (OR 6.26, 95 % CI 3.85-10.17, I = 30 %), <37 weeks (OR 5.34, 95 % CI 3.68-7.76, I = 15 %) and delivery within 14 days of testing (OR 13.95, 95 % CI 4.33-44.98, I = 0%) was increased among women with a positive fetal Fibronectin (fFN) test who were either symptomatic or asymptomatic for preterm birth. Similarly, higher odds of preterm birth was also seen among twin pregnancies asymptomatic for preterm birth with a positive fFN test at gestations <32 weeks (OR 10.54, 95 % CI 5.66-19.64, I = 19 %), < 34 weeks (OR 8.07, 95 % CI 5.28-12.33, I = 0%) and < 37 weeks (OR 6.21, 95 % CI 4.34-8.87, I = 0%). As for other biomarkers, a significantly higher odds of preterm birth <37 weeks was seen among women with elevated maternal serum human Chorionic Gonadotrophin (mshCG) (OR 1.51, 95 % CI 1.07-2.13, I = 0%), 25 Hydroxy Vitamin D level <75 nmol/l (OR 2.59, 95 % CI 1.35-4.95, I=NA), positive phosphorylated Insulin-like Growth Factor Binding Protein-1 (phIGFBP-1) (OR 4.23, 95 % CI 1.97-9.09, I = 0%) and in those with elevated Interleukin 8 (IL-8) (OR 3.13, 95 % CI 1.18-8.34, I=NA). A higher odds of preterm birth at <34 weeks gestation was seen among women with maternal serum Alpha fetoprotein (AFP)>3.5 MoM (OR 2.35, 95 % CI 1.12-4.96, I=NA) while higher odds of preterm birth at <32 weeks was seen among women with 25 Hydroxy Vitamin D level <75 nmol/l (OR 3.01, 95 % CI 1.26-7.19, I=NA). Delivery within seven days of testing was significantly increased in women with a positive Matrix Metallo Protein-8 (MMP-8) test (OR 10.59, 95 % CI 3.70-30.29, I=NA). Fetal Fibronectin is strongly associated with predicting preterm birth among women with twin pregnancies who are either asymptomatic or symptomatic for preterm birth as well as in those asymptomatic for preterm birth. Other biomarkers have shown a positive association in the prediction of preterm birth among women with twin pregnancies. Further studies are recommended to evaluate their role.
Topics: Female; Fibronectins; Gestational Age; Humans; Infant, Newborn; Odds Ratio; Pregnancy; Pregnancy, Twin; Premature Birth
PubMed: 32446146
DOI: 10.1016/j.ejogrb.2020.04.015 -
Arab Journal of Gastroenterology : the... Mar 2021The relationship between the alpha-fetoprotein (AFP) level and the prognosis of hepatocellular carcinoma (HCC) after surgical resection remains unknown. This study aims... (Meta-Analysis)
Meta-Analysis
BACKGROUND AND STUDY AIMS
The relationship between the alpha-fetoprotein (AFP) level and the prognosis of hepatocellular carcinoma (HCC) after surgical resection remains unknown. This study aims to assess this relationship.
PATIENTS AND METHODS
PubMed and Web of Science were systematically utilised. Meta-analysis was conducted for the outcomes of the recurrence-free survival (RFS) and the overall survival (OS) by comparing the high AFP group with the low AFP group.
RESULTS
The studies included 61 manuscripts with 35,461 patients. The summary hazard ratio (HR) for RFS was 1.501 (95% CI 1.355-1.662; Z = 7.81, P < 0.00001) when comparing the high AFP group with the low AFP group. Sensitivity analysis only included adjusted HRs, with the summary HR being 1.563 (95% CI 1.381-1.768; Z = 7.10, P < 0.00001). The summary HR for OS was 1.565 (95% CI 1.439-1.701; Z = 10.52, P < 0.00001) when comparing two AFP groups. Sensitivity analysis showed that the summary HR was 1.611 (95% CI 1.456-1.782; Z = 9.24, P < 0.00001).
CONCLUSION
Our meta-analysis indicated that elevated serum AFP levels are associated with poor prognosis of HCC after surgical resection.
Topics: Carcinoma, Hepatocellular; Hepatectomy; Humans; Liver Neoplasms; Prognosis; alpha-Fetoproteins
PubMed: 33551350
DOI: 10.1016/j.ajg.2020.09.004 -
World Journal of Gastroenterology Sep 2020Hepatocellular carcinoma (HCC) is a frequent cause of cancer related death globally. Neutrophil to lymphocyte ratio (NLR) and albumin bilirubin (ALBI) grade are emerging...
BACKGROUND
Hepatocellular carcinoma (HCC) is a frequent cause of cancer related death globally. Neutrophil to lymphocyte ratio (NLR) and albumin bilirubin (ALBI) grade are emerging prognostic indicators in HCC.
AIM
To study published literature of NLR and ALBI over the last five years, and to validate NLR and ALBI locally in our centre as indicators of HCC survival.
METHODS
A systematic review of the published literature on PubMed of NLR and ALBI in HCC over the last five years. The search followed the guidelines of the preferred reporting items for systematic reviews and meta-analyses. Additionally, we also investigated HCC cases between December 2013 and December 2018 in our centre.
RESULTS
There were 54 studies describing the relation between HCC and NLR and 95 studies describing the relation between HCC and ALBI grade over the last five years. Our local cohort of patients showed NLR to have a significant negative relationship to survival ( = 0.011). There was also significant inverse relationship between the size of the largest HCC nodule and survival ( = 0.009). Median survival with alpha fetoprotein (AFP) < 10 KU/L was 20 mo and with AFP > 10 KU/L was 5 mo. We found that AFP was inversely related to survival, this relationship was not statically significant ( = 0.132). Mean survival for ALBI grade 1 was 37.7 mo, ALBI grade 2 was 13.4 months and ALBI grade 3 was 4.5 mo. ALBI grades performed better than Child Turcotte Pugh score in detecting death from HCC.
CONCLUSION
NLR and ALBI grade in HCC predict survival better than the conventional alpha fetoprotein. ALBI grade performs better than Child Turcotte Pugh score. These markers are done as part of routine clinical care and in cases of normal alpha fetoprotein, these markers could give a better understanding of the patient disease progression. NLR and ALBI grade could have a role in modified easier to learn staging and prognostic systems for HCC.
Topics: Albumins; Bilirubin; Carcinoma, Hepatocellular; Child; Humans; Liver Neoplasms; Lymphocytes; Neutrophils; Prognosis; Retrospective Studies
PubMed: 32952347
DOI: 10.3748/wjg.v26.i33.5022 -
BJOG : An International Journal of... Sep 2016Controversies about the performance of conventional prenatal screening using maternal serum and ultrasound markers (PSMSUM) in detecting Down syndrome (DS) have been... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Controversies about the performance of conventional prenatal screening using maternal serum and ultrasound markers (PSMSUM) in detecting Down syndrome (DS) have been raised as a result of a recently available noninvasive prenatal test based on cell-free fetal DNA sequencing.
OBJECTIVES
To evaluate the screening performance of PSMSUM in detecting DS in Chinese women.
SEARCH STRATEGY
An exhaustive literature search of MEDLINE, Embase, the Cochrane Library, ISI Web of Science and China BioMedical Disc.
SELECTION CRITERIA
Primary studies, published from January 2004 to November 2014, which examined the screening accuracy of PSMSUM in pregnant Chinese women, compared with a reference standard, either chromosomal verification or inspection of the newborn.
DATA COLLECTION AND ANALYSIS
Data were extracted as screening positive/negative results for Down and non-Down syndrome pregnancies, allowing estimation of sensitivities and specificities. Risks of bias within and across studies were assessed. Screening accuracy measures were pooled using a bivariate random effects regression model.
MAIN RESULTS
Seventy-eight studies, involving six categories of PSMSUM, were included. Second-trimester double serum [pooled sensitivity (SEN) = 0.80, pooled specificity (SPE) = 0.95] and triple-serum (pooled SEN = 0.79, pooled SPE = 0.96) screening were the predominant PSMSUM methods. The screening performances of these methods achieved the national standard but varied enormously across studies. First-trimester combined screening (pooled SEN = 0.92, pooled SPE = 0.93) and second-trimester quadruple serum screening (median SEN = 0.86, median SPE = 0.96) performed better, but were rarely used.
AUTHOR'S CONCLUSIONS
Second-trimester maternal serum screening has the potential to achieve satisfactory screening performance in middle- and low-income countries. The reported enormous range in screening performance of second-trimester PSMSUM calls for urgent implementation of methods for performance optimization.
TWEETABLE ABSTRACT
Meta-analysis results show good accuracy of maternal serum and ultrasound screening for trisomy 21 in Chinese women.
Topics: Asian People; Biomarkers; China; Chorionic Gonadotropin; Chorionic Gonadotropin, beta Subunit, Human; Down Syndrome; Female; Humans; Maternal Age; Maternal Serum Screening Tests; Pregnancy; Pregnancy-Associated Plasma Protein-A; Prenatal Diagnosis; Ultrasonography; alpha-Fetoproteins
PubMed: 27627591
DOI: 10.1111/1471-0528.14009 -
The Turkish Journal of Gastroenterology... Mar 2020Previous study has shown a positive relationship between the hepatitis B virus (HBV) or hepatitis C virus (HCV) infection and cholangiocarcinoma (CCA); however, their... (Meta-Analysis)
Meta-Analysis
BACKGROUND/AIMS
Previous study has shown a positive relationship between the hepatitis B virus (HBV) or hepatitis C virus (HCV) infection and cholangiocarcinoma (CCA); however, their correlation with different anatomical sites of CCA (i.e. ICC and ECC) has not been revealed. This study aims to evaluate the association of HBV or HCV infection with CCA, including the intrahepatic cholangiocarcinoma (ICC) and extrahepatic cholangiocarcinoma (ECC), and to determine the roles of α-1 fetoprotein (AFP), CA19-9, and lymph node involvement in CCA with HBV infection.
MATERIALS AND METHODS
Relevant studies published between 2004 and 2016 were systematically searched and retrieved from PubMed, SpringerLink, and Science Direct using key terms such as "cholangiocarcinoma", "bile duct cancer", "extrahepatic cholangiocarcinoma", and "intrahepatic cholangiocarcinoma". The demographic, clinical, and laboratory data were extracted from the included studies, and the meta-analysis was performed using RevMan and STATA 11.0 software.
RESULTS
A total of 13 studies with CCA matched the inclusion criteria in this meta-analysis, including 7,113 CCA patients and 24,763 controls. This meta-analysis showed that the HBV or HCV infections can significantly increase the risk of CCA, including ICC and ECC. In addition, the higher levels of AFP, lower levels of CA19-9, and lymph node involvement were detected in the CCA patients with HBV infection as compared to those without.
CONCLUSION
The HBV and HCV infections significantly increased the risk of CCA, as well as ICC and ECC. The involvement of AFP, CA19-9, and lymph nodes may play an important role in the diagnosis of CCA.
Topics: Adult; Aged; Antigens, Tumor-Associated, Carbohydrate; Bile Duct Neoplasms; Bile Ducts, Extrahepatic; Bile Ducts, Intrahepatic; Cholangiocarcinoma; Female; Hepacivirus; Hepatitis B; Hepatitis B virus; Hepatitis C; Humans; Lymph Nodes; Male; Middle Aged; Risk Factors; alpha-Fetoproteins
PubMed: 32343237
DOI: 10.5152/tjg.2020.19056 -
Journal of Ethnopharmacology Jan 2024Transcatheter arterial chemoembolization (TACE) is recommended as the first-line therapy for unresected primary liver cancer (PLC), but only partial patients could... (Meta-Analysis)
Meta-Analysis
ETHNOPHARMACOLOGICAL RELEVANCE
Transcatheter arterial chemoembolization (TACE) is recommended as the first-line therapy for unresected primary liver cancer (PLC), but only partial patients could benefit from TACE due to the serious adverse reactions. Clearing heat and resolving toxin (CHRT), one of most critical traditional Chinese medicine (TCM) therapeutic principles, has been widely used in the treatment of PLC patients especially after TACE. However, there is no enough clinical evidence to confirm the efficacy and safety of the combined therapy.
AIM OF THE STUDY
To comprehensively evaluate the efficacy and safety of the combined CHRT-CHF with TACE in the treatment of PLC.
MATERIALS AND METHODS
7 databases were searched from their inception until February 1, 2023. The primary outcomes included survival rate (1-, 2-year), objective response rate (ORR) and disease control rate (DCR), liver function indicators (AST, ALT), adverse reactions including fever, upper digestive tract side and myelosuppression, AFP were selected as the secondary outcomes. RevMan5.4 software was used to evaluate the quality of included studies; meta-analysis, subgroup analysis, meta-regression analysis, publication bias and trial sequential analyses (TSA) was conducted by Stata software 12.0.
RESULTS
There were 40 RCTs involving 3649 patients. Patients treated with TACE plus CHRT-CHF showed significantly better 1-, 2-year survival (respectively: OR, 2.23 [1.67-2.97]; OR, 2.13 [1.56-2.92]), ORR (OR, 2.14 [1.82-2.52]), DCR (OR, 2.13 [1.73-2.62]) compared with TACE alone. There was a decreased incidence of aspartate transaminase (AST), alanine transaminase (ALT), alpha-fetoprotein (AFP) and postembolization syndrome (PES) in patients receiving the combined TACE with CHRT-CHF compared with TACE alone. Subgroup analysis found that lower proportion (20-30%) of CHRT-CHF significantly enhanced survival rate and DCR, higher proportion (≥40%) of CHRT-CHF reduced PES after TACE treatment.
CONCLUSION
The efficacy and safety of the combined CHRT-CHF with TACE were validated in this meta-analysis, the optimal proportion of CHRT-CHF in enhancing the efficacy may be 20-30%; Additionally, higher proportion (≥40%) of CHRT-CHF appears to reduce PES after TACE treatment. The potential role of combined relative proportion of CHRT-CHF with TACE should be emphasized in clinic.
Topics: Humans; Carcinoma, Hepatocellular; Liver Neoplasms; alpha-Fetoproteins; Chemoembolization, Therapeutic; Hot Temperature; Treatment Outcome
PubMed: 37625603
DOI: 10.1016/j.jep.2023.117072