title: Conventional transarterial chemoembolization vs microsphere embolization in hepatocellular carcinoma: a meta-analysis.
abstract: OBJECTIVE
  To compare conventional transarterial chemoembolization (c-TACE) with microsphere embolization in hepatocellular carcinoma (HCC).
  
  
  METHODS
  We searched PubMed, Medline, Embase and the Cochrane Library for trials assessing the efficacy and safety of c-TACE in comparison with those of yttrium-90 microsphere or drug-eluting bead embolization from January 2004 to December 2013. Overall survival rate (OSR), tumor response [complete response, partial response (PR), stable disease (SD), progressive disease (PD)], α-fetoprotein (AFP) response, progression rate and complications were compared and analyzed. Pooled ORs with 95%CI were calculated using either the fixed-effects model or random-effects model. All statistical analyses were conducted using the Review Manager (version 5.1.) from the Cochrane collaboration.
  
  
  RESULTS
  Thirteen trials were identified, including a total of 1834 patients; 1233 were treated with c-TACE, 377 underwent yttrium-90 microsphere embolization and 224 underwent drug-eluting bead embolization. The meta-analysis with either the random-effects model or fixed-effects model indicated that microsphere embolization was associated with significantly higher OSRs compared with those of c-TACE (OR(1-year) = 1.38, 95%CI(1-year): 1.05-1.82; OR(2-year) = 2.88, 95%CI(2-year): 1.18-7.05; OR(3-year) = 2.15, 95%CI(3-year): 1.18-3.91). The complete tumor response rates of patients who underwent microspheres embolization were significantly higher than those of patients treated with c-TACE (OR = 2.19, 95%CI: 1.31-3.64). The tumor progression rate after microsphere embolization was markedly lower than that after c-TACE (OR = 0.56, 95%CI: 0.39-0.81). There was no significant difference between microsphere embolization and c-TACE in PR (OR = 0.73, 95%CI: 0.47-1.15), SD (OR = 1.07, 95%CI: 0.79-1.44), PD (OR = 0.75, 95%CI: 0.33-1.68), AFP response (OR = 1.38, 95%CI: 0.64-2.94) and complications (OR = 0.68, 95%CI: 0.46-1.00).
  
  
  CONCLUSIONS
  Our analysis indicated that microsphere embolization was associated with superior survival and treatment response in comparison with c-TACE in the treatment of patients with HCC.
authors.affiliation: Jia-Yan Ni, Lin-Feng Xu, Wei-Dong Wang, Hong-Liang Sun, Yao-Ting Chen, Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510210, Guangdong Province, China.
authors.forename: Jia-Yan
authors.initials: JY
authors.lastname: Ni
authors.affiliation: Jia-Yan Ni, Lin-Feng Xu, Wei-Dong Wang, Hong-Liang Sun, Yao-Ting Chen, Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510210, Guangdong Province, China.
authors.forename: Lin-Feng
authors.initials: LF
authors.lastname: Xu
authors.affiliation: Jia-Yan Ni, Lin-Feng Xu, Wei-Dong Wang, Hong-Liang Sun, Yao-Ting Chen, Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510210, Guangdong Province, China.
authors.forename: Wei-Dong
authors.initials: WD
authors.lastname: Wang
authors.affiliation: Jia-Yan Ni, Lin-Feng Xu, Wei-Dong Wang, Hong-Liang Sun, Yao-Ting Chen, Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510210, Guangdong Province, China.
authors.forename: Hong-Liang
authors.initials: HL
authors.lastname: Sun
authors.affiliation: Jia-Yan Ni, Lin-Feng Xu, Wei-Dong Wang, Hong-Liang Sun, Yao-Ting Chen, Department of Interventional Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510210, Guangdong Province, China.
authors.forename: Yao-Ting
authors.initials: YT
authors.lastname: Chen
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D018450:Disease Progression; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008863:Microspheres; D016017:Odds Ratio; D012074:Remission Induction; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: Drug-eluting bead; Hepatocellular carcinoma; Meta-analysis; Transarterial chemoembolizaiton; Yttrium-90 microsphere