Meta-analysis: adjusted indirect comparison of drug-eluting bead transarterial chemoembolization versus 90Y-radioembolization for hepatocellular carcinoma
- 504 Downloads
To investigate comparative effectiveness of drug-eluting bead transarterial chemoembolization (DEB-TACE) versus Yttrium-90 (90Y)-radioembolization for hepatocellular carcinoma (HCC).
Studies comparing conventional (c)TACE versus 90Y-radioembolization or DEB-TACE for HCC treatment were identified using PubMed/Medline, Embase, and Cochrane databases. The adjusted indirect meta-analytic method for effectiveness comparison of DEB-TACE versus 90Y-radioembolization was used. Wilcoxon rank-sum test was used to compare baseline characteristics. A priori defined sensitivity analysis of stratified study subgroups was performed for primary outcome analyses. Publication bias was tested by Egger’s and Begg’s tests.
Fourteen studies comparing DEB-TACE or 90Y-radioembolization with cTACE were included. Analysis revealed a 1-year overall survival benefit for DEB-TACE over 90Y-radioembolization (79 % vs. 54.8 %; OR: 0.57; 95 %CI: 0.355-0.915; p = 0.02; I-squared: 0 %; p > 0.5), but not for the 2-year (61 % vs. 34 %; OR: 0.65; 95%CI: 0.294-1.437; p = 0.29) and 3-year survival (56.4 % vs. 20.9 %; OR: 0.713; 95 % CI: 0.21-2.548; p = 0.62). There was significant heterogeneity in the 2- and 3-year survival analyses. The pooled median overall survival was longer for DEB-TACE (22.6 vs. 14.7 months). There was no significant difference in tumour response rate.
DEB-TACE and 90Y-radioembolization are efficacious treatments for patients suffering from HCC; DEB-TACE demonstrated survival benefit at 1-year compared to 90Y-radioembolization but direct comparison is warranted for further evaluation.
• This meta-analysis shows greater 1-year survival benefit for DEB-TACE over 90 Y-radioembolization.
• DEB-TACE has a favourable 2- & 3-year survival benefit trend over 90 Y-radioembolization.
• No significant difference for tumour response was detected.
• Direct comparison of these methods for a more robust evaluation is warranted.
KeywordsInterventional Radiology Meta-Analysis Drug-Eluting Bead Transarterial Chemoembolization (DEB-TACE) Yttrium-90 Radioembolization Hepatocellular Carcinoma
Barcelona Clinic Liver Cancer
convectional Transarterial Chemoembolization
Drug-Eluting-Bead Transarterial Chemoembolization
Randomized Controlled Trial
Complete tumour Response
Partial tumour Response
modified Response Evaluation Criteria in Solid Tumours
Response Evaluation Criteria in Solid Tumours
World Health Organization
European Association for the Study of the Liver
Portal Vein Thrombosis
The scientific guarantor of this publication is: Dr Hyun S. Kim. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. (Co-author: Zhang, Di). Institutional review board approval was not required because of literature-based research. Methodology: Meta-Analysis
- 1.Howlader N, Noone A, Krapcho M et al (2013) SEER cancer statistics review, 1975-2011. National Cancer Institute, Bethesda, MD. Available via http://seer.cancer.gov/csr/1975_2011/. Accessed 17 Nov 2014
- 10.Huang K, Zhou Q, Wang R, Cheng D, Ma Y (2013) Doxorubicin-eluting bead versus conventional transarterial chemoembolization for the treatment of HCC: a meta-analysis (Provisional abstract). J Gastroenterol HepatolGoogle Scholar
- 14.Pitton MB, Kloeckner R, Ruckes C et al (2014) Randomized Comparison of Selective Internal Radiotherapy (SIRT) Versus Drug-Eluting Bead Transarterial Chemoembolization (DEB-TACE) for the Treatment of Hepatocellular Carcinoma. Cardiovasc Intervent Radiol. doi: 10.1007/s00270-014-1012-0 PubMedPubMedCentralGoogle Scholar
- 35.Salem R, Lewandowski RJ, Gates VL et al (2011) Research reporting standards for radioembolization of hepatic malignancies. J Vasc Interv Radiol 22:265–278Google Scholar
- 40.Prajapati HJ, Rafi S, El-Rayes BF, Kauh JS, Kooby DA, Kim HS (2012) Safety and feasibility of same-day discharge of patients with unresectable hepatocellular carcinoma treated with doxorubicin drug-eluting bead transcatheter chemoembolization. J Vasc Interv Radiol 23:1286–1293, e1281CrossRefPubMedGoogle Scholar