肝细胞癌（HCC）在全球癌症发病率中排名第六，在死亡率中排名第三。不幸的是，超过70%的HCC患者由于体检不充分、身体状况不佳以及诊断时可用的器官有限而放弃了根治性手术或肝移植的机会。临床指南认可经动脉化疗栓塞 (TACE) 作为中晚期 HCC 的一线治疗方法。冷冻消融 (CRA) 是一种新兴的局部消融疗法，越来越多地用于 HCC 治疗。最近的研究表明，CRA 与 TACE 相结合可产生互补和协同效应，有可能提高长期生存率。但对于直径≥5 cm的HCC病灶，联合TACE CRA治疗相对于单独TACE的优越性还需要进一步研究。 比较TACE联合CRA与单独TACE治疗直径≥5 HCC的疗效和安全性cm.PubMed、EMBASE、Cochrane Library、CNKI、万方、VIP数据库检索截至2022年7月所有关于TACE和CRA的相关研究，采用RevMan 5.3软件进行Meta分析。根据纳入和排除进行筛选后标准纳入6篇文章，其中随机对照试验2篇，非随机对照试验4篇，总计575例患者纳入荟萃分析。结果显示，客观缓解率[比值比（OR）=2.56，95%置信区间（CI）：1.66-3.96，P < 0.0001），疾病控制率（OR=3.03，95%CI：1.88-4.89， P < 0.00001)、1 年生存率 (OR = 3.79, 95%CI: 2.50-5.76, P < 0.00001)、2 年生存率 (OR = 2.34, 95%CI: 1.43-3.85, P = 0.0008) 、3年生存率（OR=3.34，95%CI：1.61-6.94，P=0.001）均优于对照组；术后甲胎蛋白值下降（OR = 295.53，95%CI：250.22-340.85，P < 0.0001），术后CD4值增加（OR = 10.59，95%CI：8.78-12.40，P < 0.00001），术后CD8值下降幅度（OR = 6.47，95%CI：4.44-8.50，P < 0.00001）也显着高于单独TACE治疗组。与单独TACE治疗相比，TACE CRA联合治疗组没有明显改善。不仅能提高直径≥5cm的HCC患者的免疫功能，还能增强治疗效果和长期生存率，且不会增加并发症的风险。因此，对于直径≥5cm的HCC患者，TACE CRA联合治疗可能是更推荐的治疗方法。©作者2024。百事登出版集团有限公司出版。保留所有权利。

Hepatocellular carcinoma (HCC) ranks sixth globally in cancer incidence and third in mortality rates. Unfortunately, over 70% of HCC patients forego the opportunity for curative surgery or liver transplantation due to inadequate physical examinations, poor physical condition, and limited organ availability upon diagnosis. Clinical guidelines endorse transarterial chemoembolization (TACE) as the frontline treatment for intermediate to advanced-stage HCC. Cryoablation (CRA) is an emerging local ablative therapy increasingly used in HCC management. Recent studies suggest that combining CRA with TACE offers complementary and synergistic effects, potentially improving long-term survival rates. However, the superiority of combined TACE + CRA therapy over TACE alone for HCC lesions equal to or exceeding 5 cm requires further investigation.To compare the efficacy and safety of TACE combined with CRA vs TACE alone in the treatment of HCC with a diameter of ≥ 5 cm.PubMed, EMBASE, Cochrane Library, CNKI, Wanfang, and VIP databases were searched to retrieve all relevant studies on TACE and CRA up to July 2022. Meta-analysis was performed using RevMan 5.3 software.After screening according to the inclusion and exclusion criteria, 6 articles were included, including 2 randomized controlled trials and 4 nonrandomized controlled trials, with a total of 575 patients included in the meta-analysis. The results showed that the objective response rate [odds ratio (OR) = 2.56, 95% confidence interval (CI):1.66-3.96, P < 0.0001), disease control rate (OR = 3.03, 95%CI: 1.88-4.89, P < 0.00001), 1-year survival rate (OR = 3.79, 95%CI: 2.50-5.76, P < 0.00001), 2-year survival rate (OR = 2.34, 95%CI: 1.43-3.85, P = 0.0008), and 3-year survival rate (OR = 3.34, 95%CI: 1.61-6.94, P = 0.001) were all superior to those of the control group; the postoperative decrease in alpha-fetoprotein value (OR = 295.53, 95%CI: 250.22-340.85, P < 0.0001), the postoperative increase in CD4 value (OR = 10.59, 95%CI: 8.78-12.40, P < 0.00001), and the postoperative decrease in CD8 value (OR = 6.47, 95%CI: 4.44-8.50, P < 0.00001) were also significantly higher than those in the TACE-alone treatment group.Compared with TACE-alone treatment, TACE + CRA combined treatment not only improves the immune function of HCC patients with a diameter of ≥ 5 cm, but also enhances the therapeutic efficacy and long-term survival rate, without increasing the risk of complications. Therefore, TACE + CRA combined treatment may be a more recommended treatment for patients with HCC with a diameter of ≥ 5 cm.©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.