title: Transarterial embolization with or without chemotherapy for advanced hepatocellular carcinoma: a systematic review.
abstract: Transarterial chemoembolization (TACE) and transarterial embolization (TAE) are commonly used as first-line treatment for patients with advanced hepatocellular carcinoma (HCC) and have been shown to improve overall survival (OS). However, there remain concerns regarding whether the benefit of the prolonged survival achieved with TACE is superior to the maximum cytotoxic effect of the associated chemotherapeutics. This systematic review aims to compare the efficiency of TACE and TAE based on randomized controlled trials (RCTs). MEDLINE, EMBASE, the Cochrane library, the Science Citation Index, and the Chinese National Knowledge Infrastructure databases were systematically searched through the end of April 2014. Risk ratios (RRs) and 95 % confidence intervals (CIs) were calculated. Meta-analysis of the RCTs was conducted to estimate the mortality and survival rate between the TACE and TAE groups. The analysis included five RCTs involving 582 patients. For all-cause mortality, TACE did not result in a statistically significant reduced incidence of adverse events than TAE with a pooled RR of 1.21 (95 % CI = 0.74-1.98, P = 0.16). In addition, 6-, 9-, 12-, 24-, and 36-month OS of the TACE group were not significantly higher than that of the TAE group (all P > 0.05). Interestingly, TACE resulted in a significantly higher rate of advanced events. The efficacy of TACE is not superior to TAE in advanced HCC patients. Moreover, TACE was associated with an increased rate of adverse events than TAE. Improved strategies are needed to reduce the risk of post-TACE complications.
authors.affiliation: Hepatobiliary Surgery Department, Affiliated Tumor Hospital of Guangxi Medical University, He Di Rd. #71, Nanning, 530021, People's Republic of China.
authors.forename: Zhi-Bo
authors.initials: ZB
authors.lastname: Xie
authors.forename: Liang
authors.initials: L
authors.lastname: Ma
authors.forename: Xiao-Bo
authors.initials: XB
authors.lastname: Wang
authors.forename: Tao
authors.initials: T
authors.lastname: Bai
authors.forename: Jia-Zhou
authors.initials: JZ
authors.lastname: Ye
authors.forename: Jian-Hong
authors.initials: JH
authors.lastname: Zhong
authors.forename: Le-Qun
authors.initials: LQ
authors.lastname: Li
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007269:Injections, Intra-Arterial; D008113:Liver Neoplasms / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents