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

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objective

To investigate comparative effectiveness of drug-eluting bead transarterial chemoembolization (DEB-TACE) versus Yttrium-90 (90Y)-radioembolization for hepatocellular carcinoma (HCC).

Methods

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.

Results

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.

Conclusion

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.

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Abbreviations

HCC:

Hepatocellular Carcinoma

BCLC:

Barcelona Clinic Liver Cancer

TACE:

Transarterial Chemoembolization

cTACE:

convectional Transarterial Chemoembolization

90Y:

Yttrium-90

DEB-TACE:

Drug-Eluting-Bead Transarterial Chemoembolization

RCT:

Randomized Controlled Trial

OS:

Overall Survival

CR:

Complete tumour Response

PR:

Partial tumour Response

AE:

Adverse Events

OR:

Odds Ratio

mRECIST:

modified Response Evaluation Criteria in Solid Tumours

CI:

Confidence Interval

RECIST:

Response Evaluation Criteria in Solid Tumours

WHO:

World Health Organization

EASL:

European Association for the Study of the Liver

AFP:

Alpha-1-Fetoprotein

PVT:

Portal Vein Thrombosis

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Acknowledgments

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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Authors and Affiliations

  1. Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, TE 2-224, New Haven, CT, 06510, USA

    Johannes M. Ludwig, Minzhi Xing & Hyun S. Kim

  2. Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA

    Di Zhang

  3. Yale Cancer Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA

    Hyun S. Kim

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  1. Johannes M. Ludwig
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  2. Di Zhang
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  3. Minzhi Xing
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  4. Hyun S. Kim
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Correspondence to Hyun S. Kim.

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Ludwig, J.M., Zhang, D., Xing, M. et al. Meta-analysis: adjusted indirect comparison of drug-eluting bead transarterial chemoembolization versus 90Y-radioembolization for hepatocellular carcinoma. Eur Radiol 27, 2031–2041 (2017). https://doi.org/10.1007/s00330-016-4548-3

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