title: Meta-analysis: adjusted indirect comparison of drug-eluting bead transarterial chemoembolization versus90Y-radioembolization for hepatocellular carcinoma.
abstract: OBJECTIVE
  To investigate comparative effectiveness of drug-eluting bead transarterial chemoembolization (DEB-TACE) versus Yttrium-90 (90Y)-radioembolization for hepatocellular carcinoma (HCC).
  
  
  METHODS
  Studies comparing conventional (c)TACE versus90Y-radioembolization or DEB-TACE for HCC treatment were identified using PubMed/Medline, Embase, and Cochrane databases. The adjusted indirect meta-analytic method for effectiveness comparison of DEB-TACE versus90Y-radioembolization was used. Wilcoxon rank-sum test was used to compare baseline characteristics. A priori defined sensitivity analysis of stratified study subgroups was performed for primary outcome analyses. Publication bias was tested by Egger's and Begg's tests.
  
  
  RESULTS
  Fourteen studies comparing DEB-TACE or90Y-radioembolization with cTACE were included. Analysis revealed a 1-year overall survival benefit for DEB-TACE over90Y-radioembolization (79 % vs. 54.8 %; OR: 0.57; 95 %CI: 0.355-0.915; p = 0.02; I-squared: 0 %; p > 0.5), but not for the 2-year (61 % vs. 34 %; OR: 0.65; 95%CI: 0.294-1.437; p = 0.29) and 3-year survival (56.4 % vs. 20.9 %; OR: 0.713; 95 % CI: 0.21-2.548; p = 0.62). There was significant heterogeneity in the 2- and 3-year survival analyses. The pooled median overall survival was longer for DEB-TACE (22.6 vs. 14.7 months). There was no significant difference in tumour response rate.
  
  
  CONCLUSIONS
  DEB-TACE and90Y-radioembolization are efficacious treatments for patients suffering from HCC; DEB-TACE demonstrated survival benefit at 1-year compared to90Y-radioembolization but direct comparison is warranted for further evaluation.
  
  
  CONCLUSIONS
  • This meta-analysis shows greater 1-year survival benefit for DEB-TACE over90Y-radioembolization. • DEB-TACE has a favourable 2- & 3-year survival benefit trend over90Y-radioembolization. • No significant difference for tumour response was detected. • Direct comparison of these methods for a more robust evaluation is warranted.
authors: Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, TE 2-224, New Haven, CT, 06510, USA.
authors: Johannes M
authors: JM
authors: Ludwig
authors: Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
authors: Di
authors: D
authors: Zhang
authors: Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, TE 2-224, New Haven, CT, 06510, USA.
authors: Minzhi
authors: M
authors: Xing
authors: Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, TE 2-224, New Haven, CT, 06510, USA. kevin.kim@yale.edu.|Yale Cancer Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA. kevin.kim@yale.edu.
authors: Hyun S
authors: HS
authors: Kim
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D004621:Embolization, Therapeutic / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes
keywords: Drug-Eluting Bead Transarterial Chemoembolization (DEB-TACE); Hepatocellular Carcinoma; Interventional Radiology; Meta-Analysis; Yttrium-90 Radioembolization