Du Xue, Zhang Xiaoting
Xue Du Department of Hepatobiliary Pain Interventional Diagnosis and Treatment Center, Lishui Central Hospital, Lishui, Zhejiang Province 323000, P.R. China.
Xiaoting Zhang Department of Hematology, Lishui Central Hospital, Lishui, Zhejiang Province 323000, P.R. China.
Pak J Med Sci. 2025 Apr;41(4):1234-1243. doi: 10.12669/pjms.41.4.11718.
BACKGROUND & OBJECTIVE: The efficacy of transarterial chemoembolization (TACE) in different populations of hepatocellular carcinoma (HCC) patients is still unclear. This meta-analysis explores the impact of TACE on survival outcomes in elderly versus younger patients with HCC, considering regional variations and heterogeneity among studies.
Nineteen studies involving 30,093 participants were systematically reviewed from January 1964 to January 2024. Data were pooled using random-effects models to calculate hazard ratios (HRs) and odds ratios (ORs) with 95% confidence intervals (CI) for overall survival and survival rates, respectively. Subgroup analyses were conducted based on age cut-offs and geographical regions to assess the effect of these variables on treatment outcomes.
Pooled HR for overall survival did not show a significant difference between elderly and younger patients (HR = 1.00; 95% CI: 0.98 to 1.02), with similar findings for survival rates (OR = 0.82; 95% CI: 0.46 to 1.45). Substantial heterogeneity was observed (I² = 78.0% for HR and 94.3% for OR), with notable regional differences indicating lower survival odds in European studies compared to Asian ones. No significant effect (OR = 0.95) was detected in prospective studies, while retrospective studies indicated a significant reduction in survival rates in elderly patients (OR = 0.35).
TACE appears to be equally effective in elderly and younger HCC patients. However, significant regional differences and study heterogeneity suggest the need for personalized treatment approaches. Further research is required to understand the underlying causes of these variations and to optimize TACE protocols.
经动脉化疗栓塞术（TACE）在不同人群的肝细胞癌（HCC）患者中的疗效仍不明确。本荟萃分析探讨了TACE对老年与年轻HCC患者生存结局的影响，同时考虑了研究之间的地区差异和异质性。
系统回顾了1964年1月至2024年1月期间涉及30,093名参与者的19项研究。使用随机效应模型汇总数据，分别计算总生存和生存率的风险比（HR）和比值比（OR）及其95%置信区间（CI）。基于年龄界限和地理区域进行亚组分析，以评估这些变量对治疗结局的影响。
老年与年轻患者的总生存合并HR未显示出显著差异（HR = 1.00；95% CI：0.98至1.02），生存率的结果相似（OR = 0.82；95% CI：0.46至1.45）。观察到存在显著异质性（HR的I² = 78.0%，OR的I² = 94.3%），显著的地区差异表明，与亚洲研究相比，欧洲研究中的生存几率较低。前瞻性研究未检测到显著影响（OR = 0.95），而回顾性研究表明老年患者的生存率显著降低（OR = 0.35）。
TACE在老年和年轻HCC患者中似乎同样有效。然而，显著的地区差异和研究异质性表明需要个性化的治疗方法。需要进一步研究以了解这些差异的潜在原因并优化TACE方案。
