Comparison of TACE combined with and without iodine-125 seeds implantation therapy for advanced stage hepatocellular carcinoma: a systematic review and meta-analysis

Purpose: Hepatocellular carcinoma (HCC) has the secondhighest cancer-related mortality in patients worldwide. Recently, TACE plus Iodine-125 (I-125) seed strand endovascular implantation (ISEI) was shown to be feasible in advanced HCC patients. The aim of this study was to evaluate the efficacy and safety of this combined therapy for the treatment of advanced stage HCC by meta-analysis. Methods: A systematic search in PubMed, EMBASE and Cochrane Library Databases was conducted until April 1st 2018. Outcomes included overall survival (OS), objective response rate (ORR) of primary liver tumor, and procedure-related complications. All statistical analyses were performed using Review Manager 5.3 and Stata 12.0. Results: Nine eligible studies on 1059 advanced HCC patients were included. The results showed that TACE plus ISEI had significantly improved the 6-month OS (OR, 5.01: 95%CI, 3.19 similar to 7.86: P <0. 01) and 1-year OS (OR, 4.97: 95%CI, 3.12 similar to 7.92: P<0.01) compared to TACE alone. Conclusion: The safety and efficacy of TACE plus ISEI is superior to TACE alone for advanced HCC.