Open AccessTransarterial chemoembolization vs bland embolization in hepatocellular carcinoma: A meta‐analysis of randomized trials
Author(s) -
Facciorusso Antonio,
Bellanti Francesco,
Villani Rosanna,
Salvatore Veronica,
Muscatiello Nicola,
Piscaglia Fabio,
Vendemiale Gianluigi,
Serviddio Gaetano
Publication year - 2017
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640616673516
Subject(s) - medicine , hepatocellular carcinoma , embolization , meta analysis , randomized controlled trial , adverse effect , confidence interval , relative risk , gastroenterology , carcinoma , surgery
Background Although transarterial chemoembolization is considered the standard of care for intermediate hepatocellular carcinoma patients, robust data in favor of a clear superiority of chemoembolization (with chemotherapy injection) over bland embolization are lacking. Objective The objective of this article is to systematically analyze the results provided by randomized controlled trials comparing these two treatments in hepatocarcinoma patients. Methods A computerized bibliographic search on the main databases was performed. Survival rates assessed at one, two, and three years, objective response, one‐year progression‐free survival, and severe adverse event rate were analyzed. Comparisons were performed by using the Mantel‐Haenszel test in cases of low heterogeneity or DerSimonian and Laird test in cases of high heterogeneity. Results Six trials with 676 patients were included. No difference in one‐year (risk ratio: 0.93, 0.85–1.03, p = 0.16), two‐year (risk ratio: 0.88, 0.74–1.06, p = 0.18) and three‐year survival (risk ratio: 0.97, 0.74–1.27, p = 0.81) was observed. Objective response and one‐year progression‐free survival showed no significant difference between the two treatments ( p = 0.36 and p = 0.40, respectively). A statistically significant increase in severe toxicity after chemoembolization was found (risk ratio: 1.44, 1.08–1.92, p = 0.01), although this result could be affected by the heterogeneity of techniques adopted. Conclusions Our meta‐analysis demonstrates a non‐superiority of transarterial chemoembolization with respect to bland embolization in hepatocarcinoma patients.