Conventional transarterial chemoembolization vs microsphere embolization in hepatocellular carcinoma:A meta-analysis

• Published in: World journal of gastroenterology : WJG Vol. 20; no. 45; pp. 17206 - 17217
• Main Authors: Ni, Jia-Yan, Xu, Lin-Feng, Wang, Wei-Dong, Sun, Hong-Liang, Chen, Yao-Ting
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 07.12.2014
• Subjects: carcinoma; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; che-moembol; Chemoembolization, Therapeutic - adverse effects; Chemoembolization, Therapeutic - methods; Chemoembolization, Therapeutic - mortality; Chi-Square Distribution; Disease Progression; Embolization, Therapeutic - adverse effects; Embolization, Therapeutic - methods; Embolization, Therapeutic - mortality; Hepatocellular; Humans; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Meta-Analysis; Microspheres; Odds Ratio; Remission Induction; Risk Factors; Survival Analysis; Time Factors; Transarterial; Treatment Outcome; Transarterial chemoembolizaiton; Hepatocellular carcinoma; Yttrium-90 microsphere; Drug-eluting bead; Meta-analysis
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v20.i45.17206

AIM:To compare conventional transarterial chemoembolization(c-TACE)with microsphere embolization in hepatocellular carcinoma(HCC).METHODS:We searched Pub Med,Medline,Embase and the Cochrane Library for trials assessing the efficacy and safety of c-TACE in comparison with those of yttrium-90 microsphere or drug-eluting bead embolization from January 2004 to December 2013.Overall survival rate(OSR),tumor response[complete response,partial response(PR),stable disease(SD),progressive disease(PD)],α-fetoprotein(AFP)response,progression rate and complications were compared and analyzed.Pooled ORs with 95%CI were calculated using either the fixed-effects model or random-effects model.All statistical analyses were conducted using the Review Manager(version 5.1.)from the Cochrane collaboration.RESULTS:Thirteen trials were identified,including a total of 1834 patients;1233 were treated with c-TACE,377 underwent yttrium-90 microsphere embolization and 224 underwent drug-eluting bead embolization.The meta-analysis with either the random-effects model or fixed-effects model indicated that microsphere embolization was associated with significantly higher OSRs compared with those of c-TACE(OR1-year=1.38,95%CI1-year:1.05-1.82;OR2-year=2.88,95%CI2-year:1.18-7.05;OR3-year=2.15,95%CI3-year:1.18-3.91).The complete tumor response rates of patients who underwent microspheres embolization were significantly higher than those of patients treated with c-TACE(OR=2.19,95%CI:1.31-3.64).The tumor progression rate after microsphere embolization was markedly lower than that after c-TACE(OR=0.56,95%CI:0.39-0.81).There was no significant difference between microsphere embolization and c-TACE in PR(OR=0.73,95%CI:0.47-1.15),SD(OR=1.07,95%CI:0.79-1.44),PD(OR=0.75,95%CI:0.33-1.68),AFP response(OR=1.38,95%CI:0.64-2.94)and complications(OR=0.68,95%CI:0.46-1.00).CONCLUSION:Our analysis indicated that microsphere embolization was associated with superior survival and treatment response in comparison with c-TACE in the treatment of patients with HCC.