Meta-Analysis
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 28, 2016; 8(18): 770-778
Published online Jun 28, 2016. doi: 10.4254/wjh.v8.i18.770
Transarterial radioembolization vs chemoembolization for hepatocarcinoma patients: A systematic review and meta-analysis
Antonio Facciorusso, Gaetano Serviddio, Nicola Muscatiello
Antonio Facciorusso, Nicola Muscatiello, Gastroenterology Unit, Department of Medical Sciences, University of Foggia, 71100 Foggia, Italy
Gaetano Serviddio, Internal Medicine Unit, University of Foggia, 71100 Foggia, Italy
Author contributions: Facciorusso A designed the study, performed the statistical analysis and wrote the paper; Serviddio G and Muscatiello N revised the paper; Muscatiello N collected the data.
Conflict-of-interest statement: None of the authors have received fees for serving as a speaker or are consultant/advisory board member for any organizations; None of the authors have received research funding from any organizations; None of the authors are employees of any organizations; None of the authors own stocks and/or share in any organizations; None of the authors own patents.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antonio Facciorusso, MD, Gastroenterology Unit, Department of Medical Sciences, University of Foggia, Viale L. Pinto, 1, 71100 Foggia, Italy. antonio.facciorusso@virgilio.it
Telephone: +39-0881-732154 Fax: +39-0881-732135
Received: January 30, 2016
Peer-review started: January 30, 2016
First decision: April 15, 2016
Revised: May 4, 2016
Accepted: May 31, 2016
Article in press: June 2, 2016
Published online: June 28, 2016
Processing time: 146 Days and 8.4 Hours
Abstract

AIM: To compare the efficacy and safety of yttrium-90 radioembolization (Y90RE) and transarterial chemoembolization (TACE) in hepatocellular carcinoma patients.

METHODS: Bibliographic research was conducted on main scientific databases. When there was no statistically significant heterogeneity, pooled effects were calculated using a fixed-effects model by means of Mantel-Haenszel test, otherwise, a random-effects model was used with DerSimonian and Laird test. Summary estimates were expressed in terms of odds ratios (ORs) and 95%CI. The probability of publication bias was assessed using funnel plots and with Begg and Mazumdar’s test. Sensitivity analysis was finally conducted using the method of excluding extreme data.

RESULTS: A total of 10 studies were analyzed, of which 2 randomized controlled trials. Survival rate (SR) assessed at 1 year showed an absolute similarity between the two treatment groups (OR = 1.01, 95%CI: 0.78-1.31, P = 0.93). As long as time elapsed since the treatment, ORs for survival rate tended to significantly increase, thus meaning better long-term outcomes in patients who underwent Y90RE (2-year SR: OR = 1.43, 1.08-1.89, P = 0.01; 3-year SR: OR = 1.48, 1.03-2.13, P = 0.04). Meta-analysis of plotted hazard ratios (HRs) determined a non-significant overall estimate in favor of Y90RE (HR = 0.91, 0.80-1.04, P = 0.16). Y90RE showed a statistically significant benefit as compared to TACE in terms of higher progression-free survival rate assessed at 1 year (OR = 1.67; 95%CI: 1.10-2.55; P = 0.02). Pooled analyses do not revealed a statistically significant increase in OR for tumor objective responses after Y90RE with respect to TACE (OR = 1.22, 95%CI: 0.69-2.16, P = 0.50). A non-significant trend in favor of Y90RE was observed according to adverse event rate (OR = 0.70, 0.38-1.30, P = 0.26).

CONCLUSION: Our meta-analysis reveals that Y90RE and TACE show similar effects in terms of survival, response rate and safety profile, although tumor progression is delayed after radioembolization.

Keywords: Yttrium-90 radioembolization; Transarterial chemoembolization; Hepatocellular carcinoma; Survival; Prognosis; Recurrence

Core tip: A clear evidence in support of the superiority of yttrium-90 radioembolization (Y90RE) over chemoembolization (TACE) in hepatocellular carcinoma patients is still lacking. Results of our meta-analysis reveal that Y90RE and TACE show similar effects in terms of survival, response rate and safety profile, although tumor progression is delayed after radioembolization. Similar results were found as for objective response rate and safety profile. The sole statistical difference was with regard to 1-year progression-free survival, which resulted significantly in favor of Y90RE (OR = 1.67, P = 0.02).