Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
BMC Gastroenterol. 2024 Jun 7;24(1):195. doi: 10.1186/s12876-024-03282-z.
Despite transarterial chemoembolization (TACE) was recommended as first line therapy for intermediate hepatocellular carcinoma (HCC), the efficacy of transarterial embolization (TAE) has not been widely recognized. This work was to determine whether TAE was as effective and safe as TACE for unresectable HCC.
We performed a systematic search of electronic databases and other sources for randomized controlled studies (RCTs) comparing TAE with TACE for unresectable HCC. Results were expressed as Hazard Ratio (HR) for survival and Odds Ratio (OR) for dichotomous outcomes using RevMan 5.4.1.
We included 6 trials with 683 patients. The risk of bias of included RCTs was from unclear to high risk. There were no significant differences between TACE and TAE for progression-free survival (HR 0.83, 95% CI 0.45-1.55; p = 0.57), overall survival (HR 1.10, 95% CI 0.90-1.35; p = 0.36), and objective response rate (OR 1.17, 95% CI 0.80-1.71; p = 0.42) without obvious publication bias. Sensitivity analyses confirmed the robustness of the results. TAE group reported similar or less adverse effects than TACE group in all the studies.
Our study demonstrated that TAE was as effective as TACE. Since TAE was simpler, cheaper and had less adverse effects than TACE, TAE should be a better choice in most cases where TACE was indicated for unresectable HCC.
尽管经动脉化疗栓塞术（TACE）被推荐为中危肝细胞癌（HCC）的一线治疗方法，但经动脉栓塞术（TAE）的疗效尚未得到广泛认可。本研究旨在确定 TAE 与 TACE 治疗不可切除 HCC 的疗效和安全性是否相当。
我们系统地检索了电子数据库和其他来源，以寻找比较 TAE 与 TACE 治疗不可切除 HCC 的随机对照研究（RCT）。使用 RevMan 5.4.1 软件，以生存的风险比（HR）和二分类结局的优势比（OR）表示结果。
我们纳入了 6 项包含 683 名患者的 RCT。纳入 RCT 的偏倚风险为不明确至高风险。在无进展生存期（HR 0.83，95%CI 0.45-1.55；p=0.57）、总生存期（HR 1.10，95%CI 0.90-1.35；p=0.36）和客观缓解率（OR 1.17，95%CI 0.80-1.71；p=0.42）方面，TACE 与 TAE 之间无显著差异，且无明显发表偏倚。敏感性分析证实了结果的稳健性。所有研究均表明 TAE 组的不良反应与 TACE 组相似或更少。
本研究表明 TAE 与 TACE 疗效相当。由于 TAE 比 TACE 更简单、更便宜且不良反应更少，因此在大多数需要 TACE 治疗不可切除 HCC 的情况下，TAE 应是更好的选择。
