Characteristics of studies included.

Objectives
To compare the clinical curative effects, survival and complications of recombinant human adenovirus-p53 (rAd-p53) combined with transcatheter arterial chemoembolization (TACE) versus TACE for the treatment of liver cancer.
Methods
We searched all the eligible studies of rAd-p53 plus TACE versus control group had only TACE in the treatment of liver cancer, which were retrieved from CNKI, Wanfang database, CBM, VIP, PubMed, EMBase, The Chrance of Library, Web of Science from its inception to august 2022.
Results
A total of 17 studies were included, which involved 1045 patients. The results of the meta analysis indicated that the the rAd-p53combined with TACE markedly improved the patients’ complete remission(OR = 2.19, 95% CI:1.13–4.22, P = 0.02), partial remission (OR = 2.22, 95% CI:1.67–2.94, P<0.00001), objective tumor response rate (OR = 2.58, 95% CI:1.95–3.41, P<0.00001) and disease control rate(OR = 2.39, 95% CI:1.65–3.47, P<0.00001) compared with TACE alone. And our results showed that rAd-p53combined with TACE had better survival benefit [6-month OS (OR = 3.41, 95% CI: 1.62–7.14, p = 0.001); 1-year OS (OR = 1.95, 95% CI: 1.28–2.96, p = 0.002)] and better quality of life(MD = 5.84, 95% CI:2.09–9.60, P = 0.002). In addition, the immunity of the patients was enhanced by the combination therapy, as demonstrated by the increase in the ratio of CD4+ to CD4+/CD8+. In adverse effects, except for fever in the TACE combined with rAd-p53 group, which was higher than that in the TACE group(OR = 2.62, 95% CI:2.02–3.49, P<0.00001), all other adverse effects were lower in the TACE combined with rAd-p53 group than in the TACE group.
Conclusion
RAd-p53 combined with TACE for liver cancer showed significant advantages in terms of clinical efficacy, survival rate, and safety compared to the TACE alone, and effectively improved patient quality of life and immune function.
Systematic review registration
https://inplasy.com/inplasy-2022-9-0127/.