Evaluation of drug-eluting beads versus conventional transcatheter arterial chemoembolization in patients with unresectable hepatocellular carcinoma: A systematic review and meta-analysis

Background and objectives: Transcatheter arterial chemoembolization (TACE) is the first-line treatment for unresectable hepatocellular carcinoma (HCC). It consists of conventional TACE (cTACE) and drug-eluting beads TACE (DEB-TACE). The comparative outcomes of the two methods remain controversial. The study aim to research the optimal TACE strategy for unresectable HCC. Methods: A systematic search of keywords, including 'HCC' and 'drug-eluting beads' was performed including four electronic databases: PubMed, Embase, China Biological Medicine Database (CBM), and Cochrane library databases from the date of inception to December 25, 2015. Review Manager 5.3 was used to calculate the pooled relative risks (RRs) and 95% confident intervals (CIs). Results: Sixteen cohort studies (4 RCTs, 3 prospective cohorts, 9 retrospective cohorts) were included comprising a total of 1832 patients: 822 patients with DEB-TACE therapy and 1010 patients undergoing cTACE. The 1-, 2-, and 3-year overall survival (OS) rates and 1- and 2-year relapse-free survival (RFS) rates were significantly higher in DEB-TACE group, with pooled RRs of 1.12 (95% CI = 1.03-1.23, P = 0.007), 1.26 (95% CI = 1.03-1.54, P = 0.02), 1.69 (95% CI = 1.00-2.84, P = 0.04), 1.21 (95% CI = 1.01-1.44, P = 0.03) and 1.68 (95% CI = 1.17-2.43, P = 0.005). There was no statistical significance in 3-year RFS, tumor response and treatment-related adverse events. Conclusion: Compared with cTACE, DEB-TACE therapy significantly improved 1-, 2-, and 3-year OS rates and the 1- and 2- year RFS rates. (C) 2016 Elsevier Masson SAS. All rights reserved.