Efficacy and complications of transarterial chemoembolization alone or in combination with different protocols for hepatocellular carcinoma: A Bayesian network meta-analysis of randomized controlled trials

Background and aims:Transarterial chemoembolization(TACE)is the standard treatment for most intermediate-toadvanced stage hepatocellular carcinoma.With the ongoing development of interventional therapies,TACE in combination with different protocols is being explored.A network meta-analysis to collect recent evidence in this field is required.Methods:We searched PubMed,Web of Science,Cochrane Central Register of Controlled Trials,Embase,Chinese National Knowledge Infrastructure database,Cochrane Library,and Wanfang database from their inception to May 2022 for randomized controlled trials(RCTs)that reported TACE in combination with different protocols for hepatocellular carcinoma.Results:In total,67 RCTs assessing eight combination treatments were included.The quality of primary outcomes was from moderate to low.The Bayesian network meta-analysis confirmed that TACE combined with iodine-125 seed implantation had the highest probability of 1-year survival rate and TACE combined with sorafenib had the highest probability of 2-year survival rate.TACE alone had the highest probability of incidence of fever,TACE combined with sorafenib had the highest probability of incidence of pain and TACE combined with percutaneous ethanol injection had the highest probability of incidence of nausea and vomiting.Conclusion:This Bayesian network meta-analysis found that TACE combined with iodine-125 seed and TACE combined with sorafenib may benefit patients in terms of 1-year survival and 2-year survival,respectively.To confirm this conclusion,high-quality and well-designed RCTs with a larger sample size are needed.

腹腔镜胆总管探查术一期缝合术后胆漏危险因素Meta分析

目的探讨腹腔镜胆总管探查术(LCBDE)一期缝合术后胆漏的危险因素。方法检索PubMed、Embase、Cochrane Library、Web of Science、知网、万方、维普等数据库1990年1月1日至2022年5月1日关于LCBDE一期缝合术后胆漏危险因素的临床研究。中文检索词:胆总管结石、腹腔镜胆总管探查、胆漏、危险因素。英文检索词:choledocholithiasis、common bile duct stone、laparoscopic common bile duct exploration、LCBDE、bile leakage。对研究报道数量≥3的指标进行Meta分析。结果最终纳入7项研究共930例患者,其中男431例,女499例。Meta分析结果显示,术前血ALB<35 g/L的患者术后胆漏发生率明显高于术前血ALB≥35 g/L的患者(OR=2.23,95%CI:1.16~4.28);术中胆总管切开长度<1.5 cm的患者术后胆漏发生率明显低于切开长度≥1.5 cm的患者(OR=0.42,95%CI:0.20~0.87);胆总管连续缝合患者术后胆漏发生率明显低于间断缝合患者(OR=0.51,95%CI:0.29~0.90);胆总管直径<1 cm的患者术后胆漏发生率明显高于胆总管直径≥1 cm的患者(OR=4.00,95%CI:2.23~7.17)。结论选择胆总管直径<1 cm患者,术前纠正血ALB水平,术中切开胆总管长度控制1.5 cm以内,切口采用连续缝合可有效降低LCBDE一期缝合术后胆漏发生风险。

Transarterial chemoembolization in combination with programmed death-1/programmed cell death-ligand 1 immunotherapy for hepatocellular

Hepatocellular carcinoma(HCC)is one of the most common malignancies worldwide.With the development of systemic therapies,several studies are currently underway,especially those related to the use of programmed death-1/programmed cell death-ligand 1(PD-1/PD-L1)immunotherapy.Moreover,studies on transarterial che-moembolization(TACE)and PD-1/PD-L1 immunotherapy have demonstrated some interesting outcomes.This article reviewed the current clinical evidence on the combination of TACE and PD-1/PD-L1 immunotherapy.Overall,our review summarized that a favorable survival time could be achieved using this combination in most patients.However,complications such as hyperprogression should be taken seriously,and the underlying mechanisms need to be explored.