载药微球经动脉化疗栓塞术与传统经动脉化疗栓塞术治疗肝细胞癌的疗效、生存率及安全性：一项荟萃分析

Treatment Response, Survival, and Safety of Transarterial Chemoembolization With CalliSpheres Microspheres Versus Conventional Transarterial Chemoembolization in Hepatocellular Carcinoma: A Meta-Analysis.

作者信息

Liang Bin, Makamure Joyman, Shu Shenglei, Zhang Lijie, Sun Tao, Zheng Chuansheng

机构信息

Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

出版信息

Front Oncol. 2021 Mar 16;11:576232. doi: 10.3389/fonc.2021.576232. eCollection 2021.

BACKGROUND

Drug-eluting embolic transarterial chemoembolization (DEE-TACE) is an advance in TACE technique. However, at present there is insufficient evidence to support that DEE-TACE is superior to conventional TACE (cTACE) for hepatocellular carcinoma (HCC). The aim of this meta-analysis is to evaluate the efficacy and safety of TACE with CalliSpheres microspheres (CSM-TACE) compared with cTACE in patients with HCC.

DATA SOURCES

PubMed, Embase, Web of Science, CNKI and Wanfang Databases were searched to identify relevant articles published before March 26, 2020. The data regarding treatment response, survival profile, adverse events and liver function indexes were retrieved.

RESULTS

A total of 16 studies with 1454 HCC patients (722 treated with CSM-TACE and 732 with cTACE) were included. Patients receiving CSM-TACE had higher 1-month complete response (CR), objective response rate (ORR), disease control rate (DCR) (odds ratio (OR): 2.00, 95% confidence interval (95% CI): 1.29-3.09; OR: 2.87, 95% CI: 2.15-3.83; OR: 2.01, 95% CI: 1.37-2.95, respectively), 3-month CR, ORR, DCR (OR: 4.04, 95%CI: 2.46-6.64; OR: 3.39, 95%CI: 2.45-4.70; OR: 1.71, 95%CI: 1.14-2.55 respectively), and 6-month CR, ORR, DCR (OR: 4.02, 95%CI: 2.26-7.16; OR: 3.00, 95%CI: 2.05-4.38; OR: 2.66, 95%CI: 1.70-4.16 respectively) than those treated with cTACE. Furthermore, CSM-TACE exhibited a trend toward improved progression free survival (hazard ratio (HR): 0.86, 95%CI: 0.67-1.11) and overall survival (HR: 0.79, 95%CI: 0.59-1.07) over cTACE although these differences did not reach statistical significance. In terms of safety, the two TACE treatments showed similar post-treatment pain (OR: 0.84, 95%CI: 0.55-1.28), fever (OR: 0.99, 95%CI: 0.60-1.63), nausea/vomiting (OR: 0.84, 95% CI: 0.60-1.17), as well as 1-month follow-up alanine aminotransferase (Mean difference (MD): -3.66, 95%CI: -10.38-3.07), aspartate aminotransferase (MD: -2.30, 95%CI: -8.91-4.31) and total bilirubin (MD: -0.15, 95%CI: -2.26-1.96).

CONCLUSION

CSM-TACE displays superior treatment response, non-inferior survival profile and safety over cTACE in HCC patients.

背景

载药栓塞经动脉化疗栓塞术（DEE-TACE）是经动脉化疗栓塞术（TACE）技术的一项进展。然而，目前尚无充分证据支持DEE-TACE在肝细胞癌（HCC）治疗中优于传统TACE（cTACE）。本荟萃分析的目的是评估与cTACE相比，使用载药微球的TACE（CSM-TACE）治疗HCC患者的疗效和安全性。

数据来源

检索了PubMed、Embase、Web of Science、中国知网和万方数据库，以识别2020年3月26日前发表的相关文章。检索了有关治疗反应、生存情况、不良事件和肝功能指标的数据。

结果

共纳入16项研究，涉及1454例HCC患者（722例接受CSM-TACE治疗，732例接受cTACE治疗）。与接受cTACE治疗的患者相比，接受CSM-TACE治疗的患者在1个月时的完全缓解（CR）、客观缓解率（ORR）、疾病控制率（DCR）更高（优势比（OR）分别为：2.00，95%置信区间（95%CI）：1.29 - 3.09；OR：2.87，95%CI：2.15 - 3.83；OR：2.01，95%CI：1.37 - 2.95），3个月时的CR、ORR、DCR更高（OR分别为：4.04，95%CI：2.46 - 6.64；OR：3.39，95%CI：2.45 - 4.70；OR：1.71，95%CI：1.14 - 2.55），6个月时的CR、ORR、DCR更高（OR分别为：4.02，95%CI：2.26 - 7.16；OR：3.00，95%CI：2.05 - 4.38；OR：2.66，95%CI：1.70 - 4.16）。此外，与cTACE相比，CSM-TACE在无进展生存期（风险比（HR）：0.86，95%CI：0.67 - 1.11）和总生存期（HR：0.79，95%CI：0.59 - 1.07）方面有改善趋势，尽管这些差异未达到统计学意义。在安全性方面，两种TACE治疗在治疗后疼痛（OR：0.84，95%CI：0.55 - 1.28）、发热（OR：0.99，95%CI：0.60 - 1.63）、恶心/呕吐（OR：0.84，95%CI：0.60 - 1.17）以及1个月随访时的丙氨酸氨基转移酶（平均差（MD）： - 3.66，95%CI： - 10.38 - 3.07）、天冬氨酸氨基转移酶（MD： - 2.30，95%CI： - 8.91 - 4.31）和总胆红素（MD： - 0.15，95%CI： - 2.26 - 1.96）方面表现相似。