Transarterial Chemoembolization Plus Sorafenib versus Transarterial Chemoembolization Alone for Advanced Hepatocellular Carcinoma: An Umbrella Review of Meta-Analyses and Systematic Reviews

Jingxin Yan; Yonghao Wen; Manjun Deng; Bin Ye; Xinlian Liu; Lushun Zhang

doi:10.2147/JHC.S429352

Transarterial Chemoembolization Plus Sorafenib versus Transarterial Chemoembolization Alone for Advanced Hepatocellular Carcinoma: An Umbrella Review of Meta-Analyses and Systematic Reviews

J Hepatocell Carcinoma. 2023 Oct 5:10:1723-1733. doi: 10.2147/JHC.S429352. eCollection 2023.

Authors

Jingxin Yan^#^{1

2}, Yonghao Wen^#^{1

3}, Manjun Deng^{1

2}, Bin Ye⁴, Xinlian Liu⁵, Lushun Zhang⁵

Affiliations

¹ Department of Hepatopancreatobiliary Surgery, Affiliated Hospital of Qinghai University, Xining, People's Republic of China.
² Qinghai Province Key Laboratory of Hydatid Disease Research, Xining, People's Republic of China.
³ Department of Postgraduate, Qinghai University, Xining, People's Republic of China.
⁴ Department of General Surgery, Rongxian People's Hospital, Zigong, People's Republic of China.
⁵ Department of Pathology and Pathophysiology, Chengdu Medical College, Chengdu, People's Republic of China.

^# Contributed equally.

Abstract

Background: Sorafenib is the standard treatment for most cases of advanced hepatocellular carcinoma (HCC), based on Western and Eastern clinical guidelines. Thus, an increasing number of transarterial chemoembolization (TACE) plus sorafenib combination therapies have been used in clinical practice. In addition, several systematic reviews and meta-analyses have explored the efficacy and safety of the combination of TACE and sorafenib. Therefore, we performed an umbrella review to summarize and evaluate these evidence-based studies.

Methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched up to June 1, 2023. All meta-analyses that evaluated the effect of TACE plus sorafenib on HCC were considered eligible. The quality of the included meta-analyses was evaluated by AMSTAR2 (A Measurement Tool to Assess Systematic Reviews). The quality of evidence per association provided in the meta-analyses was rated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). This study was registered with PROSPERO (Registration ID: CRD42023420417).

Results: We included 12 meta-analyses, including randomized clinical trials, cohort studies, and observational studies. A total of 44 associations with overall survival, survival rate, time to disease progression, overall response rate, disease control rate, and adverse events were evaluated in this umbrella review. The quality of most associations ranged from low to very low, indicating that flaws were significant in the current meta-analyses.

Conclusion: This umbrella review identified beneficial associations between TACE and sorafenib combination therapy in advanced HCC. However, owing to the low certainty of the evidence, clinicians should interpret our results with caution when applying them in clinical practice, and high-quality studies are required in the future to confirm our results.

Keywords: hepatocellular carcinoma; meta-analysis; sorafenib; systematic review; transarterial chemoembolization; umbrella review.

Publication types

Review