Transarterial strategies for the treatment of unresectable hepatocellular carcinoma: A systematic review

PLoS One. 2020 Feb 19;15(2):e0227475. doi: 10.1371/journal.pone.0227475. eCollection 2020.

Abstract

Conventional transarterial chemoembolization (cTACE), drug-eluting beads (DEB-TACE) and transarterial radioembolization (TARE) are alternative strategies for unresectable hepatocellular carcinoma (HCC). However, which of these strategies is the best is still controversial. This meta-analysis was performed to evaluate the effects of DEB-TACE, TARE and cTACE in terms of overall survival (OS), tumor response and complications. A literature search was conducted using the EMBASE, PubMed, Google Scholar, and Cochrane databases from inception until July 2019 with no language restrictions. The primary outcome was overall survival, and the secondary outcomes included complete response and local recurrence. The comparison of DEB-TACE with cTACE indicated that DEB-TACE has a better OS at 1 year (RR 0.79, 95% CI 0.67-0.93, p = 0.006), 2 years (RR 0.89; 95% CI 0.81-0.99, p = 0.046), and 3 years (RR 0.89; 95% CI 0.81-0.99, p = 0.035). The comparison of TARE with cTACE indicated that TARE has a better OS than cTACE at 2 years (RR 0.87; 95% CI 0.80-0.95, p = 0.003) and 3 years (RR 0.90; 95% CI 0.85-0.96, p = 0.001). The comparison of DEB-TACE with TARE indicated that DEB-TACE has a better OS than TARE at 2 years (RR 0.40; 95% CI 0.19-0.84, p = 0.016). The current meta-analysis suggests that DEB-TACE is superior to both TARE and cTACE in terms of OS. TARE has significantly lower complications than both DEB-TACE and cTACE for patients with HCC. Further multicenter, well-designed randomized controlled trials are needed, especially for evaluating DEB-TACE versus TARE.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Carcinoma, Hepatocellular / blood supply*
  • Carcinoma, Hepatocellular / pathology
  • Chemoembolization, Therapeutic / adverse effects
  • Disease-Free Survival
  • Hepatic Artery / pathology*
  • Humans
  • Liver Neoplasms / blood supply*
  • Liver Neoplasms / pathology
  • Proportional Hazards Models
  • Publication Bias
  • Survival Analysis

Grants and funding

This study was sponsored by Department of Science & Technology of Sichuan Province of China (2017SZ0014) to ZYL. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.