Abstract Background and aims The existing evidence has indicated that hyperthermia ablation (HA) and HA combined with transarterial chemoembolization (HATACE) are the optimal alternative to surgical resection for patients with hepatocellular carcinoma (HCC) in the COVID‐19 crisis. However, the evidence for decision‐making is lacking in terms of comparison between HA and HATACE. Herein, a comprehensive evaluation was performed to compare the efficacy and safety of HATACE with monotherapy. Materials and Methods Worldwide studies were collected to evaluate the HATACE regimen for HCC due to the practical need for global extrapolation of applicative population. Meta‐analyses were performed using the RevMan 5.3 software (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). Results Thirty‐six studies involving a large sample of 5036 patients were included finally. Compared with HA alone, HATACE produced the advantage of 5‐year overall survival (OS) rate (OR:1.90; 95%CI:1.46,2.46; p < 0.05) without increasing toxicity ( p ≥ 0.05). Compared with TACE alone, HATACE was associated with superior 5‐year OS rate (OR:3.54; 95%CI:1.96,6.37; p < 0.05) and significantly reduced the incidences of severe liver damage (OR:0.32; 95%CI:0.11,0.96; p < 0.05) and ascites (OR:0.42; 95%CI:0.20,0.88; p < 0.05). Subgroup analysis results of small (≤3 cm) HCC revealed that there were no significant differences between the HATACE group and HA monotherapy group in regard to the OS rates ( p ≥ 0.05). Conclusions Compared with TACE alone, HATACE was more effective and safe for HCC. Compared with HA alone, HATACE was more effective for non‐small‐sized (>3 cm) HCC with comparable safety. However, the survival benefit of adjuvant TACE in HATACE regimen was not found for the patients with small (≤3 cm) HCC. In this study, we have demonstrated that HATACE for HCC is superior to TACE monotherapy with respect to either efficacy or safety. HATACE is more effective than HA monotherapy with comparable safety for non‐small‐sized (>3 cm) HCC. Compared with HATACE, HA monotherapy could provide comparable survival benefit for the patients with small (≤3 cm) HCC. Namely, adjuvant TACE is not necessary for HA therapy in treating small HCC. Although there are some deficiencies as discussed in the limitations section, this research could provide a comprehensive reference for clinical decision‐making on the base of the 36 included studies and the adequately large sample size of 5036 patients. In addition, we should pay more attention to HA and HATACE due to their superiorities in the SAUCCC.
【저자키워드】 COVID‐19, SARS‐CoV‐2, meta‐analysis, Hepatocellular carcinoma, hyperthermia ablation, transarterial chemoembolization, 【초록키워드】 Efficacy, therapy, Toxicity, COVID‐19, survival, Research, Patient, Efficacy and safety, incidence, monotherapy, Denmark, patients, collaboration, Liver damage, HCC, Evidence, Analysis, Safe, regimen, deficiency, no significant difference, limitation, material, surgical resection, large sample, effective, benefit, TACE, Result, produced, performed, collected, evaluate, significantly, indicated, the patient, addition, was performed, reduced, demonstrated, comparable, 【제목키워드】 systematic review, monotherapy, hyperthermia, hepatocellular,