Drug-Eluting Beads Versus Conventional Transarterial Chemoembolization For Hepatocellular Carcinoma:A Meta-Analysis

Background and Objective:Transarterial chemoembolization (TACE) is the first-line treatment for unresectable hepatocellular carcinoma (HCC).It includes conventional transarterial chemoembolization (cTACE) and drug-eluting beads transarterial chemoembolization (DEB-TACE).There is still controversy about the efficacy and safety of cTACE and DEB-TACE in the treatment of primary hepatocellular carcinoma.The purpose of this study is to evaluate the efficacy and safety of these two methods in the treatment of primary hepatocellular carcinoma,in order to provide more evidence-based medical basis for clinical treatment decisions..Methods:We searched the relative databases such as PubMed,Embase,the Cochrane Library,China National Knowledge Infrastructure (CNKI),China Biology Medicine Disc (CBMdisc),Wanfang Sci-tech Journal full-text Database and VIP Chinese Sci-tech Journal Database for the literature which compared the efficacy and safety of cTACE and DEB-TACE in the treatment of primary hepatocellular carcinoma.We screened the literature according to the inclusion and exclusion criteria and evaluated the quality of the included literature.After extracting the original data,we used RevMan5.3 software for statistical analysis.Results:A total of 16 clinical studies with 1349 patients were ultimately included in this meta-analysis as required.The meta-analysis showed that DEB-TACE could improve the complete response rate (OR=1.83,95%CI [1.39,2.40],P<0.0001),objective response rate (OR=2.67,95%CI [2.06,3.46],P<0.00001),disease control rate (OR=2.08,95%CI [1.56,2.76],P<0.00001)and AFP response rate (OR=4.26,95%CI[1.82,9.93],P=0.0008),and decrease progressive disease rate (OR=0.45,95%CI[0.33,0.61],P<0.00001) compared with cTACE.In addition,DEB-TACEsignificantly improved the 1-year survival rate (OR=2.00,95%CI [1.33,3.02],P=0.0009)and 2-year survival rate (OR=2.48,95%CI [1.21,5.05],P=0.01) compared with cTACE.There was no statistically significant difference in the partial response rate (OR=1.26,95%CI [0.99,1.62],P=0.07),stable disease rate(OR=0.89,95%CI[0.64,1.24],P=0.48)and serious adverse events rate(OR=0.71,95%CI [0.34,1.47],P=0.35) between the two treatments.Conclusions:Compared with cTACE,DEB-TACE provides significantly better tumor response to the treatment of primary hepatocellular carcinoma,and can improve the1-year survival rate and 2-year survival rate of patients.There was no significant difference in the incidence of serious adverse events between the two treatments.