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聯合TACE治療原發性肝癌合并脾功能亢進效果觀察. 山東醫藥, 2009, 49(6): 105-106.
4.	徐曉翌, 劉合代, 黃騫, 等. 部分脾動脈栓塞在合并脾亢肝癌患者介入治療中的臨床觀察. 浙江實用醫學, 2011, 16(5): 329-330.
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8.	于洪波, 李擁軍,張衛華, 等. 原發性肝癌合并脾功能亢進33例行雙栓塞治療效果分析. 交通醫學, 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, 謝松柏, 周有喜, 等. 肝動脈栓塞加部分脾栓塞治療原發性肝癌伴脾亢的臨床研究. 中國腫瘤臨床, 1998, 25(1): 47-50.
12.	陶正龍, 程永德, 金洪先, 等. 原發性肝癌伴門脈高壓的肝脾聯合栓塞對肝功能的影響. 介入放射學雜志, 2004, 13(4): 328-330.
13.	章萬勇, 查云飛. TACE聯合部分脾栓塞術對肝癌患者免疫功能影響研究. 臨床放射學雜志, 2015, 34(3): 451-454.
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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, 柴曉娜, 等. TACE及PSE聯合治療對肝癌患者肝功能及微循環狀態的影響. 實用放射學雜志, 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聯合TACE治療原發性肝癌合并脾功能亢進效果觀察. 山東醫藥, 2009, 49(6): 105-106.
4. 徐曉翌, 劉合代, 黃騫, 等. 部分脾動脈栓塞在合并脾亢肝癌患者介入治療中的臨床觀察. 浙江實用醫學, 2011, 16(5): 329-330.
5. 張永山, 潘光明. 肝癌伴脾功能亢進雙介入治療的臨床研究. 吉林醫學, 2011, 32(28): 5922-5923.
6. 張金龍, 張軍華, 韓萍, 等. 肝動脈化療栓塞術聯合功能性脾動脈血流栓塞術治療原發性肝細胞癌合并脾功能亢進的臨床觀察. 中國綜合臨床, 2014, 30(12): 1309-1311.
7. 李倩, 于友濤, 王曉偉,等. 肝動脈化療栓塞術聯合脾栓塞術治療肝癌脾亢的臨床應用價值. 標記免疫分析與臨床, 2015, 22(8): 729-735.
8. 于洪波, 李擁軍,張衛華, 等. 原發性肝癌合并脾功能亢進33例行雙栓塞治療效果分析. 交通醫學, 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, 謝松柏, 周有喜, 等. 肝動脈栓塞加部分脾栓塞治療原發性肝癌伴脾亢的臨床研究. 中國腫瘤臨床, 1998, 25(1): 47-50.
12. 陶正龍, 程永德, 金洪先, 等. 原發性肝癌伴門脈高壓的肝脾聯合栓塞對肝功能的影響. 介入放射學雜志, 2004, 13(4): 328-330.
13. 章萬勇, 查云飛. TACE聯合部分脾栓塞術對肝癌患者免疫功能影響研究. 臨床放射學雜志, 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. P?lsson 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, 柴曉娜, 等. TACE及PSE聯合治療對肝癌患者肝功能及微循環狀態的影響. 實用放射學雜志, 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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