Drug-eluting beads versus conventional chemoembolization for the treatment of unresectable hepatocellular carcinoma: A meta-analysis

Background: Despite the promising results of earlier studies, a clear superiority of drug-eluting beads transarterial chemoembolization over conventional chemoembolization in unresectable hepatocellular carcinoma patients has not been established yet.

Aims: To evaluate the efficacy and safety of the two treatments in unresectable hepatocellular carcinoma patients.

Methods: Computerized bibliographic search on the main databases was performed. One-year, two-year, three-year survival rates were analyzed. Hazard ratios from Kaplan-Meier curves were extracted in order to perform an unbiased comparison of survival estimates. Objective response and severe adverse event rate were analyzed too.

Results: Four randomized-controlled trials and 8 observational studies with 1449 patients were included in the meta-analysis. Non-significant trends in favor of drug-eluting beads chemoembolization were observed as for 1-year (odds ratio: 0.76, 0.48-1.21, p=0.25), 2-year (odds ratio: 0.68, 0.42-1.12, p=0.13) and 3-year survival (odds ratio: 0.57, 0.32-1.01, p=0.06). Meta-analysis of plotted hazard ratios confirmed this trend (hazard ratio: 0.86, 0.71-1.03, p=0.10). Pooled data of objective response showed no significant difference between the two treatments (odds ratio: 1.21, 0.69-2.12, p=0.51). No statistically significant difference in adverse events was registered (odds ratio: 0.85, 0.60-1.20, p=0.36).

Conclusions: Our results stand for a non-superiority of drug-eluting beads chemoembolization with respect to conventional chemoembolization in hepatocarcinoma patients.