ObjectiveTo investigate the short-term efficacy, long-term efficacy, and adverse effects of elemene combined with transcatheter arterial chemoembolization (TACE) in the treatment of primary liver cancer (PLC). MethodsPubMed, EMBASE, Cochrane Library, Chinese Scientific Journal Full-Text Database, Wanfang Data, CBM, and VIP were searched by two reviewers using the same search strategy for clinical studies on elemene combined with TACE in the treatment of PLC. The Jadad quality scoring system was used to assess the quality of the studies included, and Review Manager 5.2 software was used for the meta-analysis. ResultsA total of 9 articles involving 487 patients were included. The results of the meta-analysis showed that compared with the TACE group, the elemene-TACE group showed significant increases in the response rate, disease control rate, and 12- and 24-month survival rates (response rate: RR=1.43, 95%CI： 1.23-1.67, P＜0.001; disease control rate: RR=1.22, 95%CI: 1.11-1.32, P＜0.001; 12-month survival rate: RR=1.68, 95%CI: 1.22-2.31, P=0.001; 24-month survival rate: RR=2.91, 95%CI: 1.44-5.87, P=0.003). As for the incidence of adverse events, the elemene-TACE group showed a significant reduction in the incidence rate of abdominal pain (RR=0.59, 95%CI: 0.36-0.98, P=0.04). ConclusionCompared with TACE alone, elemene combined with TACE might improve response rate, disease control rate, and survival rates and reduce adverse events in patients with liver cancer.