Meta-Analysis
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2024; 16(12): 4728-4737
Published online Dec 15, 2024. doi: 10.4251/wjgo.v16.i12.4728
Efficacy and safety of transhepatic arterial chemoembolization with drug-loaded microspheres in unresectable primary liver cancer
Jun Deng, Yan-Hong Mi, Le Xie, Xiong-Xing Sun, Dan-Hong Liu, Hua-Jun Long, Li-Yong He, Da-Hua Wu, Hong-Cai Shang
Jun Deng, Da-Hua Wu, Department of Integrated Traditional Chinese and Western Medicine, Hunan University of Traditional Chinese Medicine, Changsha 410208, Hunan Province, China
Jun Deng, Le Xie, Xiong-Xing Sun, Da-Hua Wu, Department of Neurology, Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Changsha 410208, Hunan Province, China
Yan-Hong Mi, Department of Prevention Diseases, Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Changsha 410006, Hunan Province, China
Dan-Hong Liu, Institute of Clinical Pharmacology of Traditional Chinese Medicine, Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Changsha 410006, Hunan Province, China
Hua-Jun Long, Department of Emergency, Hunan Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Changsha 410006, Hunan Province, China
Li-Yong He, Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510062, Guangdong Province, China
Hong-Cai Shang, State Key Laboratory of Internal Medicine of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing 100700, China
Co-first authors: Jun Deng and Yan-Hong Mi.
Co-corresponding authors: Da-Hua Wu and Hong-Cai Shang.
Author contributions: Deng J wrote the manuscript; Mi YH, Xie L, Sun XX, Liu DH, Long HJ and He LY collected the data; Wu DH and Shang HC guided the study; All authors reviewed, edited, and approved the final manuscript and revised it critically for important intellectual content, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.
Supported by Scientific Research project of Hunan Provincial Health Commission, No. B202303077689; and Hunan Natural Science Foundation Project, No. 2023JJ40397.
Conflict-of-interest statement: The authors declare no conflicts of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Cai Shang, PhD, Professor, State Key Laboratory of Internal Medicine of Traditional Chinese Medicine, Beijing University of Chinese Medicine, No. 5 Sea Warehouse, Dongcheng District, Beijing 100700, China. shanghongcai@126.com
Received: May 5, 2024
Revised: August 11, 2024
Accepted: August 20, 2024
Published online: December 15, 2024
Processing time: 191 Days and 5.1 Hours
Abstract
BACKGROUND

Transhepatic arterial chemoembolization (TACE), as a local treatment, has been widely used in the treatment of unresectable liver cancer. The introduction of drug carrier microspheres has brought new hope for the therapeutic effect of TACE. Microspheres can realize the slow release and directional delivery of drugs, reduce systemic toxicity and improve local curative effect.

AIM

To compare the effectiveness of traditional transcatheter arterial chemoembolization against microsphere-assisted transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma that is incurable.

METHODS

We searched the PubMed, Embase, Cochrane Library, and CNKI databases for clinical trials of drug-luting beads TACE (DEB-TACE) vs conventional TACE (cTACE) for the treatment of unresectable liver cancer. We screened references based on inclusion and exclusion criteria and then selected valid data for meta-analysis using RevMan 53 software. The complete response (CR) rate, partial response (PR) rate, postoperative stable disease (SD) rate, and 6-month and 12-month survival rates were compared.

RESULTS

A total of 12 articles were included, including 1177 patients, 519 of whom received DEB-TACE and 658 of whom received cTACE. The CR rate in the DEB-TACE group was much greater than that in the cTACE group [relative risk (RR) = 1.42, 95%CI: 1.18–1.72, P = 0.0002]. The 12-month survival rate significantly increased (RR = 1.09; 95%CI: 1.01- 1.17, P = 0.03); the PR rate (RR = 1.13; 95%CI: 0.97-1.30, P = 0.12); the SD rate (RR = 0.82; 95%CI: 0.64-1.05, P = 0.12); and the 6-month survival rate (RR = 1.05; 95%CI: 1.00-1.10, P = 0.07). There was no significant difference (P < 0.05).

CONCLUSION

Compared with those of iodized oil TACE, the drug-loaded microspheres tended to have therapeutic advantages.

Keywords: Transhepatic arterial chemoembolization; Drug-loaded microspheres; Unresectable primary liver cancer; Meta-analysis

Core Tip: This study systematically evaluated the efficacy and safety of transhepatic arterial chemoembolization with drug-loaded microspheres in the treatment of unresectable primary liver cancer. Through a meta-analysis of relevant literature, the effect of this treatment in prolonging survival, relieving symptoms and improving quality of life of patients was discussed, and the incidence of adverse reactions and complications was evaluated, so as to provide more scientific treatment recommendations for clinicians.