Optimal Treatment Strategies for Hepatocellular Carcinoma: A Meta-Analysis Comparing Transarterial Chemoembolization Plus Microwave Ablation Versus Microwave Ablation Alone
Bibliographic record
Abstract
Introduction: Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality worldwide. While transarterial chemoembolization (TACE) and microwave ablation (MWA) are established treatments for unresectable HCC, the comparative efficacy of TACE combined with MWA versus MWA alone remains unclear. This is the first meta-analysis to evaluate survival, recurrence, and safety outcomes between these strategies. Methods: Following PRISMA guidelines, we systematically searched PubMed, Embase, Cochrane Library, and Web of Science (inception–April 2024) for randomized controlled trials (RCTs) and observational studies comparing TACE+MWA with MWA alone. The risk of bias was assessed using the Cochrane RoB 2.0 tool and the Newcastle-Ottawa Scale. Meta-analyses were conducted using random-effects models in RevMan Web. Results: Eight studies, comprising 1,336 patients (502 TACE+MWA, 834 MWA alone), met the inclusion criteria. TACE+MWA significantly reduced disease progression/recurrence (OR=0.64, 95% CI:0.42–0.97; p =0.04) but showed no survival benefit at 1-year (OR=1.71, 95% CI:0.79–3.72), 3-year (OR=1.47, 95% CI:0.99–2.18), or 5-year (OR=0.58, 95% CI:0.28–1.21) compared to MWA alone. Subgroup analyses revealed improved 3-year survival (OR=1.91, 95% CI:1.09–3.36; p =0.02) and reduced progression/recurrence (OR=0.44, 95% CI:0.25–0.78; p =0.005) for tumors >3 cm and <5 cm. No differences emerged in recurrence-free survival, mean survival time, or adverse events. Conclusion: TACE + MWA reduces disease progression and improves 3-year survival for tumors between 3–5 cm, whereas MWA alone may be non-inferior to the TACE + MWA combination therapy for tumors <3 cm. Future studies should standardize treatment intervals and conduct tumor-specific subgroup analyses to optimize clinical decision-making.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.017 | 0.027 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.022 | 0.063 |
| Bibliometrics | 0.006 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".