European Radiology

, Volume 27, Issue 5, pp 2031–2041 | Cite as

Meta-analysis: adjusted indirect comparison of drug-eluting bead transarterial chemoembolization versus 90Y-radioembolization for hepatocellular carcinoma

  • Johannes M. Ludwig
  • Di Zhang
  • Minzhi Xing
  • Hyun S. Kim



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.

Key Points

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.


Interventional Radiology Meta-Analysis Drug-Eluting Bead Transarterial Chemoembolization (DEB-TACE) Yttrium-90 Radioembolization Hepatocellular Carcinoma 



Hepatocellular Carcinoma


Barcelona Clinic Liver Cancer


Transarterial Chemoembolization


convectional Transarterial Chemoembolization




Drug-Eluting-Bead Transarterial Chemoembolization


Randomized Controlled Trial


Overall Survival


Complete tumour Response


Partial tumour Response


Adverse Events


Odds Ratio


modified Response Evaluation Criteria in Solid Tumours


Confidence Interval


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


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Copyright information

© European Society of Radiology 2016

Authors and Affiliations

  • Johannes M. Ludwig
    • 1
  • Di Zhang
    • 2
  • Minzhi Xing
    • 1
  • Hyun S. Kim
    • 1
    • 3
  1. 1.Division of Interventional Radiology, Department of Radiology and Biomedical ImagingYale School of MedicineNew HavenUSA
  2. 2.Department of BiostatisticsUniversity of Pittsburgh Graduate School of Public HealthPittsburghUSA
  3. 3.Yale Cancer CenterYale School of MedicineNew HavenUSA

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