High-intensity focused ultrasound versus transarterial chemoembolization for hepatocellular carcinoma: a meta-analysis

Abstract

Purpose

The application of high-intensity focused ultrasound (HIFU) in hepatocellular carcinoma (HCC) was promising. However, whether the effect of HIFU is comparable with that of transarterial chemoembolization (TACE) has not been determined.

Materials and methods

PubMed, Embase, Cochrane Library, Web of Science, WanFang Data, CqVip, CNKI, and CBM databases were searched for randomized controlled trials (RCTs), cohort studies, and case-control studies. The methodological quality of each study was evaluated. When there is no statistical heterogeneity, the fixed effect model would be used to merge data. Otherwise, the random effect model would be utilized. Sensitivity analyses were conducted by excluding one study each time. Subgroup analyses were conducted based on age, sex, tumor number, relative number of the patients with Child-Pugh C grade in each group, the percentage of patients with Child-Pugh C grade in the whole study, and tumor load. Publication bias was evaluated by Egger’s test and Begg’s test.

Results

Six cohort studies including 188 patients from HIFU group and 224 patients from TACE group were obtained for further analysis. The meta-analysis suggested HIFU and TACE showed no differences in postoperative 1-year overall survival (OS) rate, tumor response (including complete response, partial response, stable disease, and progressive disease), and postoperative complications. Moreover, compared with TACE, HIFU showed higher postoperative 6-month and 2-year OS rates. Subgroup analyses, meta regression analysis and sensitivity analyses indicated the findings above were reliable. Additionally, no potential publication bias was detected.

Conclusion

For HCC, when compared with TACE, HIFU might show comparable safety but better effect. Considering the limitations of current studies, more well-designed studies are needed to validate our conclusion.

Keywords:

• High-intensity focused ultrasound
• transarterial chemoembolization
• hepatocellular carcinoma
• effect
• meta-analysis

Acknowledgments

We are extremely thankful to authors of all the included papers for their providing suitable data for analysis.

Author contributions

Conception and design: Wang YB, Zeng HS, Salameen H, and Ding X; Administrative support: None; Provision of study materials or patients: None; Collection and assembly of data: Wang YB, Miao CM, and Chen L; Data analysis and interpretation: All authors; Manuscript writing: All authors; Final approval of manuscript: All authors.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The study was funded by Chongqing medical scientific research project [Joint project of Chongqing Health Commission and Science and Technology Bureau: No. 2021MSXM139], Postdoctoral Science Foundation of Chongqing Natural Science Foundation [No. cstc2020jcyj-bshX0033], and General program of Chongqing Natural Science Foundation [No. cstc2021jcyj-msxmX0294].

Notes on contributors

Yun-Bing Wang

Yun-Bing Wang, PhD, is a clinical doctor at The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Hou-Shuai Zeng

Hou-Shuai Zeng is a MD student at The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Haitham Salameen

Haitham Salameen, MD, is a PhD student at The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Chun-Mu Miao

Chun-Mu Miao, PhD, is a clinical doctor at The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Long Chen

Long Chen, MD, is a clinical doctor at Pidu District People’s Hospital, Chengdu, Sichuan, China.

Xiong Ding

Xiong Ding, PhD, is a professor and clinical doctor at The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.