Quantifying the Effect of Supplementation with Algae and Its Extracts on Glycolipid Metabolism: A Meta-Analysis of Randomized Controlled Trials

Aims: The effect of algae and its extract supplementation on glycolipid metabolism has not been finalized. Therefore, the purpose of the meta-analyses was to assess the effects of its supplementation on glycolipid metabolism concentration. Methods: We have systematically searched PubMed, Web of Science, the Cochrane Library and Embase to identify randomized controlled trials (RCTs) that investigated the impact of algae and its extracts supplementation on glycolipid metabolism. Effect size analysis was performed using weighted mean difference (WMD) and 95% CI between the methods of the experiment group and the control group. Subgroup analyses were performed to explore the possible influences of study characteristics. Publication bias and sensitivity analysis were also performed. Results: A total of 27 RCTs (31 trials) with 1221 participants were finally selected for the meta-analysis. The algae and its extract intervention significantly decreased glycosylated hemoglobin (HbA1c, WMD = −0.18%; 95% CI: −0.27 to −0.10; p < 0.001), high-density lipoprotein cholesterol (HDL-C, WMD = −0.22 mmol/L; 95% CI: −0.38 to −0.06; p = 0.008), and triglycerides (TC, WMD = −0.31 mmol/L; 95% CI: −0.37 to −0.25; p < 0.001) levels and increased insulin (WMD = 6.05 pmol/mL; 95% CI: 4.01 to 8.09; p < 0.001) levels. It did not significantly change the blood glucose, homeostasis model assessment-insulin resistance index (HOMA-IR), 2-h post-meal blood glucose (2hPBG) and other lipid profiles. Subgroup analyses based on the duration of intervention and subjects demonstrated that the intervention of algae and its extracts for 10 weeks or fewer and more than 40 subjects decreased TC levels (p < 0.05). Moreover, the intervention reduced TC and 2hPBG concentrations for East Asians (p < 0.05). Conclusions: Our findings provided evidence that algae and its extract interventions were beneficial for the regulation of human glycolipid metabolism. More precise RCTs on subjects are recommended to further clarify the effect of algae, seaweed polysaccharide, seaweed polypeptide, algae polyphenol and its products intervention on glycolipid metabolism.

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The Long-Lasting Effects of “Placebo Injections” in Knee Osteoarthritis: A Meta-Analysis

Cartilage ◽

10.1177/1947603520906597 ◽

2020 ◽

pp. 194760352090659 ◽

Cited By ~ 7

Author(s):

Davide Previtali ◽

Giulia Merli ◽

Giorgio Di Laura Frattura ◽

Christian Candrian ◽

Stefano Zaffagnini ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Randomized Controlled Trials ◽

Placebo Effect ◽

Meta Analysis ◽

Grey Literature ◽

Cochrane Library ◽

Controlled Trials ◽

Level Of Evidence ◽

Randomized Controlled ◽

The Impact

Objectives To quantify the placebo effect of intraarticular injections for knee osteoarthritis in terms of pain, function, and objective outcomes. Factors influencing placebo effect were investigated. Design Meta-analysis of randomized controlled trials; Level of evidence, 2. PubMed, Web of Science, Cochrane Library, and grey literature databases were searched on January 8, 2020, using the string: (knee) AND (osteoarthritis OR OA) AND (injections OR intra-articular) AND (saline OR placebo). The following inclusion criteria were used: double-blind, randomized controlled trials on knee osteoarthritis, including a placebo arm on saline injections. The primary outcome was pain variation. Risk of bias was assessed using the RoB 2.0 tool, and quality of evidence was graded following the GRADE (Grading of Recommendations Assessment, Development and Evaluation) guidelines. Results Out of 2,363 records, 50 articles on 4,076 patients were included. The meta-analysis showed significant improvements up to the 6-month follow-up: Visual Analogue Scale (VAS)-pain −13.4 mean difference (MD) (95% confidence interval [CI]: −21.7/−5.1; P < 0.001), Western Ontario and McMaster Osteoarthritis Index (WOMAC)-pain −3.3 MD (95% CI: −3.9/−2.7; P < 0.001). Other significant improvements were WOMAC-stiffness −1.1 MD (95% CI: −1.6/−0.6; P < 0.001), WOMAC-function −10.1 MD (95% CI: −12.2/−8.0; P < 0.001), and Evaluator Global Assessment −21.4 MD (95% CI: −29.2/−13.6; P < 0.001). The responder rate was 52% (95% CI: 40% to 63%). Improvements were greater than the “minimal clinically important difference” for all outcomes (except 6-month VAS-pain). The level of evidence was moderate for almost all outcomes. Conclusions The placebo effect of knee injections is significant, with functional improvements lasting even longer than those reported for pain perception. The high, long-lasting, and heterogeneous effects on the scales commonly used in clinical trials further highlight that the impact of placebo should not be overlooked in the research on and management of knee osteoarthritis.

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The Impact of Immersive and Non-Immersive Virtual Reality Trends in Sensorimotor Recovery of Post-Stroke Patients-A Meta-Analysis

Journal of Intellectual Disability - Diagnosis and Treatment ◽

10.6000/2292-2598.2021.09.05.14 ◽

2021 ◽

Vol 9 (5) ◽

pp. 555-564

Author(s):

Jaza Rizvi ◽

◽

Abid Khan ◽

Sumaira Imran Farooqui ◽

Bashir Ahmed Soomro ◽

...

Keyword(s):

Virtual Reality ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Stroke Patients ◽

Post Stroke ◽

Randomized Controlled ◽

Sensorimotor Recovery ◽

The Impact

Virtual Reality (VR) is an approach in stroke rehabilitation with ever-improving technological advancement for targeted motor rehabilitation by providing a user interface in a simulated environment with proprioceptive and visual feedback. This meta-analysis intended to evaluate the impact of immersive and non-immersive VR-based interventions compared to conventional rehabilitation in sensorimotor recovery following stroke. Randomized Controlled Trials based on the impact of VR, either immersive or non-immersive type in comparison to conventional rehabilitation on post-stroke patients (>18 years) sensorimotor recovery were searched on six databases including Google Scholar, PEDro, MEDLINE, Cochrane Library, EMBASE, and Web of Science from August to November 2020. A total of 17 randomized controlled trials on VR based intervention showed significant improvement in sensorimotor recovery following a stroke in overall FMA outcomes in comparison to the control group with pool effects in terms of SMD in a random effect model showed an impact of 0.498 at 95% CI (p<0.001) depicts a moderate effect size. An immersive and non-immersive emerging VR trend appears to be a promising therapeutic tool in sensorimotor recovery following stroke.

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Is Culture Expansion Necessary in Autologous Mesenchymal Stromal Cell Therapy to Obtain Superior Results in the Management of Knee Osteoarthritis?—Meta-Analysis of Randomized Controlled Trials

Bioengineering ◽

10.3390/bioengineering8120220 ◽

2021 ◽

Vol 8 (12) ◽

pp. 220

Author(s):

Sathish Muthu ◽

Randhi Rama Kartheek ◽

Naveen Jeyaraman ◽

Ramya Lakshmi Rajendran ◽

Manish Khanna ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Group Analysis ◽

Cochrane Library ◽

Osteoarthritis Of The Knee ◽

Controlled Trials ◽

Randomized Controlled ◽

The Impact

Study Design: Meta-analysis. Objectives: We aimed to analyze the impact of cultured expansion of autologous mesenchymal stromal cells (MSCs) in the management of osteoarthritis of the knee from randomized controlled trials (RCTs) available in the literature. Materials and Methods: We conducted independent and duplicate electronic database searches including PubMed, Embase, Web of Science, and Cochrane Library until August 2021 for RCTs analyzing the efficacy and safety of culture-expanded compared to non-cultured autologous MSCs in the management of knee osteoarthritis. The Visual Analog Score (VAS) for pain, Western Ontario McMaster University’s Osteoarthritis Index (WOMAC), Lysholm score, Knee Osteoarthritis Outcome Score (KOOS), and adverse events were the analyzed outcomes. Analysis was performed in R-platform using OpenMeta [Analyst] software. Results: Overall, 17 studies involving 767 patients were included for analysis. None of the studies made a direct comparison of the culture expanded and non-cultured MSCs, hence we pooled the results of all the included studies of non-cultured and cultured types of MSC sources and made a comparative analysis of the outcomes. At six months, culture expanded MSCs showed significantly better improvement (p < 0.001) in VAS outcome. Uncultured MSCs, on the other hand, demonstrated significant VAS improvement in the long term (12 months) in VAS (p < 0.001), WOMAC (p = 0.025), KOOS score (p = 0.016) where cultured-expanded MSCs failed to demonstrate a significant change. Culturing of MSCs did not significantly increase the complications noted (p = 0.485). On sub-group analysis, adipose-derived uncultured MSCs outperformed culture-expanded MSCs at both short term (six months) and long term (12 months) in functional outcome parameters such as WOMAC (p < 0.001, p = 0.025), Lysholm (p < 0.006), and KOOS (p < 0.003) scores, respectively, compared to their controls. Conclusions: We identified a void in literature evaluating the impact of culture expansion of MSCs for use in knee osteoarthritis. Our indirect analysis of literature showed that culture expansion of autologous MSCs is not a necessary factor to obtain superior results in the management of knee osteoarthritis. Moreover, while using uncultured autologous MSCs, we recommend MSCs of adipose origin to obtain superior functional outcomes. However, we urge future trials of sufficient quality to validate our findings to arrive at a consensus on the need for culture expansion of MSCs for use in cellular therapy of knee osteoarthritis.

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Intradiskal Injection of Methylene Blue for Discogenic Back Pain: A Meta-Analysis of Randomized Controlled Trials

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1721015 ◽

2021 ◽

Vol 82 (02) ◽

pp. 161-165

Author(s):

Ming Deng ◽

Hui Huang ◽

Yong-gang Ma ◽

Yan Zhou ◽

Qing Chen ◽

...

Keyword(s):

Methylene Blue ◽

Back Pain ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Cochrane Library ◽

Control Group ◽

Controlled Trials ◽

Randomized Controlled ◽

Pain Scores ◽

The Impact

Abstract Introduction Intradiskal injection of methylene blue has some potential in alleviating discogenic back pain. This meta-analysis aims to explore the impact of intradiskal injection of methylene blue for discogenic back pain. Methods Several databases such as PubMed, EMbase, Web of Science, EBSCO, and Cochrane Library databases have been searched through November 2019, and randomized controlled trials (RCTs) assessing the effect of intradiskal injection of methylene blue for discogenic back pain are included. Results Three RCTs are included in the meta-analysis. Overall, compared with control group for discogenic back pain, intradiskal injection of methylene blue remarkably decreased pain scores at 3 months (mean difference [MD] = –0.71; 95% confidence interval [CI] = –0.96 to –0.46; p < 0.00001) and 6 months (MD = –13.92; 95% CI = –22.31 to –5.54; p = 001) and Oswestry Disability Index (ODI) at 4 to 6 weeks (MD = –10.39; 95% CI = –16.95 to –3.83; p = 0.002) and 3 months (MD = –3.66; 95% CI = –4.85 to –2.48; p < 0.00001), but demonstrated no obvious effect on ODI at 6 months (MD = –11.76; 95% CI = –33.33 to 9.80; p = 0.28). Conclusions Intradiskal injection of methylene blue can substantially decrease pain scores and improve function for discogenic back pain.

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The Effects of Folate Supplementation on Diabetes Biomarkers Among Patients with Metabolic Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Hormone and Metabolic Research ◽

10.1055/s-0043-125148 ◽

2018 ◽

Vol 50 (02) ◽

pp. 93-105 ◽

Cited By ~ 10

Author(s):

Maryam Akbari ◽

Reza Tabrizi ◽

Kamran B. Lankarani ◽

Seyed Taghi Heydari ◽

Maryam Karamali ◽

...

Keyword(s):

Randomized Controlled Trials ◽

Metabolic Diseases ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Cochrane Library ◽

Controlled Trials ◽

Model Assessment ◽

Folate Supplementation ◽

Randomized Controlled

AbstractAlthough several studies have evaluated the effect of folate supplementation on diabetes biomarkers among patients with metabolic diseases, findings are inconsistent. This review of randomized controlled trials (RCTs) was performed to summarize the evidence on the effects of folate supplementation on diabetes biomarkers among patients with metabolic diseases. Randomized-controlled trials (RCTs) published in PubMed, EMBASE, Web of Science and Cochrane Library databases up to 1 September 2017 were searched. Two review authors independently assessed study eligibility, extracted data, and evaluated risk of bias of included studies. Heterogeneity was measured with a Q-test and with I2 statistics. Data were pooled by using the fix or random-effect model based on the heterogeneity test results and expressed as standardized mean difference (SMD) with 95% confidence interval (CI). A total of sixteen randomized controlled trials involving 763 participants were included in the final analysis. The current meta-analysis showed folate supplementation among patients with metabolic diseases significantly decreased insulin (SMD –1.28; 95% CI, –1.99, –0.56) and homeostasis model assessment of insulin resistance (HOMA-IR) (SMD –1.28; 95% CI, –1.99, –0.56). However, folate supplementation did not affect fasting plasma glucose (FPG) (SMD –0.30; 95% CI, –0.63, 0.02) and hemoglobin A1C (HbA1c) (SMD –0.29; 95% CI, –0.61, 0.03). The results of this meta-analysis study demonstrated that folate supplementation may result in significant decreases in insulin levels and HOMA-IR score, but does not affect FPG and HbA1c levels among patients with metabolic diseases.

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Zinc supplementation improves glycemic control for diabetes prevention and management: a systematic review and meta-analysis of randomized controlled trials

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqz041 ◽

2019 ◽

Vol 110 (1) ◽

pp. 76-90 ◽

Cited By ~ 19

Author(s):

Xinhui Wang ◽

Wenhui Wu ◽

Wanru Zheng ◽

Xuexian Fang ◽

Liyun Chen ◽

...

Keyword(s):

Glycemic Control ◽

Randomized Controlled Trials ◽

Zinc Supplementation ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Cochrane Library ◽

Controlled Trials ◽

Model Assessment ◽

Zinc Supplement ◽

Randomized Controlled

ABSTRACT Background Although many studies have shown that low zinc status is associated with diabetes, the putative effects of zinc supplementation on glycemic control are inconclusive. Objectives The aim of this meta-analysis of randomized controlled trials was to assess the effects of zinc supplementation in preventing and managing diabetes. Methods PubMed, Embase, and the Cochrane Library were searched for articles that were published through February 10, 2019 and contained estimates for the outcomes of interest. The pooled results were then analyzed with the use of a random-effects model. Results Thirty-two placebo-controlled interventions were extracted from 36 publications, involving a total of 1700 participants in 14 countries. Overall, compared with their respective control groups, the subjects in the zinc-supplementation group had a statistically significant reduction in fasting glucose [FG, weighted mean difference (WMD): −14.15 mg/dL; 95% CI: −17.36, −10.93 mg/dL], 2-h postprandial glucose (WMD: −36.85 mg/dL; 95% CI: −62.05, −11.65 mg/dL), fasting insulin (WMD: −1.82 mU/L; 95% CI: −3.10, −0.54 mU/L), homeostasis model assessment for insulin resistance (WMD: −0.73; 95% CI: −1.22, −0.24), glycated hemoglobin (WMD: −0.55%; 95% CI: −0.84, −0.27%), and high-sensitivity C-reactive protein (WMD: −1.31 mg/L; 95% CI: −2.05, −0.56 mg/L) concentrations. Moreover, subgroup analyses revealed that the effects of zinc supplementation on FG are significantly influenced by diabetic status and the formulation of the zinc supplement. Conclusions Our analysis revealed that several key glycemic indicators are significantly reduced by zinc supplementation, particularly the FG in subjects with diabetes and in subjects who received an inorganic zinc supplement. Together, these findings support the notion that zinc supplementation may have clinical potential as an adjunct therapy for preventing or managing diabetes. This trial was registered at PROSPERO as CRD42018111838.

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Effect of Dexmedetomidine For Thoracoscopic Surgery: A Meta-analysis of Randomized Controlled Trials

10.21203/rs.3.rs-637155/v1 ◽

2021 ◽

Author(s):

Chengjun Song ◽

Quan Lu

Keyword(s):

Randomized Controlled Trials ◽

Thoracoscopic Surgery ◽

Meta Analysis ◽

Random Effect ◽

Random Effect Model ◽

Cochrane Library ◽

Control Group ◽

Controlled Trials ◽

Randomized Controlled ◽

The Impact

Abstract Introduction: The efficacy of dexmedetomidine for thoracoscopic surgery remains controversial. We conduct a systematic review and meta-analysis to explore the impact of dexmedetomidine for thoracoscopic surgery.Methods: We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through September 2020 for randomized controlled trials (RCTs) assessing the effect of dexmedetomidine on thoracoscopic surgery. This meta-analysis is performed using the random-effect model.Results: Six RCTs involving 510 patients are included in the meta-analysis. Overall, compared with control group for thoracoscopic surgery, dexmedetomidine results in significantly reduced pain scores (SMD=-1.50; 95% CI=-2.63 to -0.37; P=0.009), anesthetic consumption (SMD=-3.91; 95% CI=-6.76 to -1.05; P=0.007), mean heart rate (SMD=-0.41; 95% CI=-0.65 to -0.18; P=0.0007), and the number of ICU stay (RR=0.39; 95% CI=0.19 to 0.80; P=0.01), but showed no obvious effect on mean blood pressure (SMD=-0.07; 95% CI=-0.45 to 0.31; P=0.72) or hospital stay (SMD=-0.61; 95% CI=-1.30 to 0.08; P=0.08). Conclusions: Dexmedetomidine supplementation can substantially improve the analgesic efficacy for thoracoscopic surgery.

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Clinical Efficacy of Perioperative Immunonutrition Containing Omega-3-Fatty Acids in Patients Undergoing Hepatectomy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Annals of Nutrition and Metabolism ◽

10.1159/000509979 ◽

2020 ◽

pp. 1-12

Author(s):

Benjian Gao ◽

Jia Luo ◽

Ying Liu ◽

Furui Zhong ◽

Xiaoli Yang ◽

...

Keyword(s):

Postoperative Complications ◽

Hospital Stay ◽

Randomized Controlled Trials ◽

Fixed Effects ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Cochrane Library ◽

Controlled Trials ◽

Randomized Controlled ◽

The Impact

Background: The effect of immunonutrition in patients undergoing hepatectomy remains unclear. This meta-analysis aimed to assess the impact of immunonutrition on postoperative clinical outcomes in patients undergoing hepatectomy. Methods: A literature search of PubMed, Cochrane Library, Web of Science, and Embase databases was performed to identify all randomized controlled trials (RCTs) exploring the effect of perioperative immunonutrition in patients undergoing hepatectomy until the end of March 10, 2020. Quality assessment and data extraction of RCTs were conducted independently by 3 reviewers. Mean difference (MD) and odds ratio (OR) with 95% confidence interval (CI) were calculated using a fixed-effects or random-effects model. The meta-analysis was performed with RevMan 5.3 software. Results: Nine RCTs involving a total of 966 patients were finally included. This meta-analysis showed that immunonutrition significantly reduced the incidences of overall postoperative complications (OR = 0.57, 95% CI: 0.34–0.95; p = 0.03), overall postoperative infectious complications (OR = 0.53, 95% CI: 0.37–0.75; p = 0.0003), and incision infection (OR = 0.50, 95% CI: 0.28–0.89; p = 0.02), and it shortened the length of hospital stay (MD = −3.80, 95% CI: −6.59 to −1.02; p = 0.007). There were no significant differences in the incidences of pulmonary infection (OR = 0.60, 95% CI: 0.32–1.12; p = 0.11), urinary tract infection (OR = 1.30, 95% CI: 0.55–3.08; p = 0.55), liver failure (OR = 0.54, 95% CI: 0.23–1.24; p = 0.15), and postoperative mortality (OR = 0.69, 95% CI: 0.26–1.83; p = 0.46). Conclusion: Given its positive impact on postoperative complications and the tendency to shorten the length of hospital stay, perioperative immunonutrition should be encouraged in patients undergoing hepatectomy.

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Efficacy of Liraglutide in Patients With Diabetic Nephropathy: A Meta-Analysis of Randomized Controlled Trials

10.21203/rs.3.rs-929327/v1 ◽

2021 ◽

Author(s):

Niroj Mali ◽

Feng Su ◽

Jie Ge ◽

WenXing Fan ◽

Jing Zhang ◽

...

Keyword(s):

Diabetic Nephropathy ◽

Blood Glucose ◽

Randomized Controlled Trials ◽

Meta Analysis ◽

Renal Outcome ◽

Cochrane Library ◽

Control Group ◽

Controlled Trials ◽

Randomized Controlled ◽

Experimental Group

Abstract Background: The efficacy of liraglutide to treat type 2 diabetic nephropathy (T2DN) remains controversial. Thus, we conducted this meta-analysis to systematically evaluate the clinical effect of liraglutide on T2DN patients. Methods: Eight databases (PubMed, Web of Science, the Cochrane Library, EMBASE, Chinese National Knowledge Infrastructure (CNKI), Wanfang database, China Science and Technology Journal Database and China Biology Medicine Database (CBM)) were searched for published articles to evaluate the clinical efficacy of liraglutide in subjects with T2DN. The Revman 5.3 and Stata 13 softwares were used for analyses and plotting. Results: A total of 18 randomized controlled trials (RCTs) with 1580 diabetic nephropathy patients were screened. We found that the levels of UACR, Scr, Cysc were lower in experimental group of T2DN patients treated with liraglutide than control group intervened without liraglutide. Liraglutide also reduced the levels of blood glucose (including FBG, PBG and HbA1c), body mass index (BMI), and anti-inflammatory indicators (TNF–α, IL-6). However, there was no significant difference in BUN and eGFR between experimental group and control group.Conclusions: Liraglutide reduced the levels of Blood Glucose, BMI, renal outcome indicators and serum inflammatory factors of patients with T2DN, suggesting the beneficial effects of liraglutide on renal function.

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Adjuvant Transarterial Chemoembolization Following Curative-Intent Hepatectomy Versus Hepatectomy Alone for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Cancers ◽

10.3390/cancers13122984 ◽

2021 ◽

Vol 13 (12) ◽

pp. 2984

Author(s):

Stepan M. Esagian ◽

Christos D. Kakos ◽

Emmanouil Giorgakis ◽

Lyle Burdine ◽

J. Camilo Barreto ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Systematic Review ◽

Randomized Controlled Trials ◽

Transarterial Chemoembolization ◽

Meta Analysis ◽

Risk Of Bias ◽

Cochrane Library ◽

Controlled Trials ◽

Curative Intent ◽

Randomized Controlled

The role of adjuvant transarterial chemoembolization (TACE) for patients with resectable hepatocellular carcinoma (HCC) undergoing hepatectomy is currently unclear. We performed a systematic review of the literature using the MEDLINE, Embase, and Cochrane Library databases. Random-effects meta-analysis was carried out to compare the overall survival (OS) and recurrence-free survival (RFS) of patients with resectable HCC undergoing hepatectomy followed by adjuvant TACE vs. hepatectomy alone in randomized controlled trials (RCTs). The risk of bias was assessed using the Risk of Bias 2.0 tool. Meta-regression analyses were performed to explore the effect of hepatitis B viral status, microvascular invasion, type of resection (anatomic vs. parenchymal-sparing), and tumor size on the outcomes. Ten eligible RCTs, reporting on 1216 patients in total, were identified. The combination of hepatectomy and adjuvant TACE was associated with superior OS (hazard ratio (HR): 0.66, 95% confidence interval (CI): 0.52 to 0.85; p < 0.001) and RFS (HR: 0.70, 95% CI: 0.56 to 0.88; p < 0.001) compared to hepatectomy alone. There were significant concerns regarding the risk of bias in most of the included studies. Overall, adjuvant TACE may be associated with an oncologic benefit in select HCC patients. However, the applicability of these findings may be limited to Eastern Asian populations, due to the geographically restricted sample. High-quality multinational RCTs, as well as predictive tools to optimize patient selection, are necessary before adjuvant TACE can be routinely implemented into standard practice. PROSPERO Registration ID: CRD42021245758.

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