Liu Jiaxi, Wang Weiwei, Zhai Huan, Ma Yanan, You Qiwen, Shao Haibo
Department of Interventional Radiology, The First Hospital of China Medical University, No.155 Nanjing North Street, Heping District, Shenyang, Liaoning, 110001, China.
Department of Biostatistics and Epidemiology, School of Public Health, China Medical University, Shenyang, 110100, People's Republic of China.
BMC Cancer. 2025 Jul 1;25(1):1036. doi: 10.1186/s12885-025-14435-y.
We performed a meta-analysis and trial sequential analysis (TSA) to compare the therapeutic efficacy and adverse events (AEs) of balloon-occluded transarterial chemoembolization (B-TACE) with conventional transarterial chemoembolization (cTACE) in treating early-to-intermediate-stage hepatocellular carcinoma (HCC).
We systematically searched PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang databases for studies comparing B-TACE and cTACE in the treatment of HCC. The outcomes included the complete response (CR) rate, objective response rate (ORR), lipiodol consumption, and adverse events (AEs). Depending on the heterogeneity assessment, either a fixed-effects or random-effects model was utilized, followed by a meta-analysis using Review Manager 5.3. Additionally, a TSA was conducted to assess the adequacy of the sample size.
Five studies including a total of 1166 patients were analyzed. This meta-analysis revealed that compared with cTACE, B-TACE significantly improved the CR rate (risk ratio [RR] = 1.21, 95% confidence interval [CI] 1.04-1.42, p = 0.02) and the ORR (RR = 1.23, 95% CI 1.09-1.38, p = 0.0006). These findings were validated using TSA, which did not require a larger information size. The TSA results indicated that B-TACE consumed more lipiodol than cTACE, potentially leading to more satisfactory embolization efficacy. In terms of AEs, only post-embolization syndrome was found to occur more frequently in patients treated with B-TACE than in those treated with cTACE (RR = 1.30, 95% CI 1.01-1.68, p = 0.04). However, the TSA suggested that additional cases are necessary to confirm this difference.
B-TACE consumed more lipiodol and demonstrated superior effects on the CR rate and ORR compared to cTACE in the treatment of HCC. Importantly, this improvement in efficacy did not correspond to a significant increase in AEs. Based on these findings, it is recommended that well-designed, large-scale randomized controlled trials be conducted to further validate and expand upon these results.
This study was registered in the international prospective register of systematic reviews PROSPERO (registration No: CRD42023489055).
我们进行了一项荟萃分析和试验序贯分析（TSA），以比较球囊闭塞经动脉化疗栓塞术（B-TACE）与传统经动脉化疗栓塞术（cTACE）在治疗早中期肝细胞癌（HCC）中的疗效和不良事件（AE）。
我们系统检索了PubMed、Web of Science、Cochrane图书馆、Embase、中国知网（CNKI）和万方数据库，以查找比较B-TACE和cTACE治疗HCC的研究。结局指标包括完全缓解（CR）率、客观缓解率（ORR）、碘油用量和不良事件（AE）。根据异质性评估结果，采用固定效应模型或随机效应模型，随后使用Review Manager 5.3进行荟萃分析。此外，还进行了TSA以评估样本量是否充足。
共分析了5项研究，总计1166例患者。该荟萃分析显示，与cTACE相比，B-TACE显著提高了CR率（风险比[RR]=1.21，95%置信区间[CI]1.04-1.42，p=0.02）和ORR（RR=1.23，95%CI 1.09-1.38，p=0.0006）。使用TSA验证了这些结果，且不需要更大的信息量。TSA结果表明，B-TACE比cTACE消耗更多的碘油，可能导致更满意的栓塞效果。在AE方面，仅发现栓塞后综合征在接受B-TACE治疗的患者中比接受cTACE治疗的患者更频繁发生（RR=1.30，95%CI 1.01-1.68，p=0.04）。然而，TSA表明需要更多病例来证实这一差异。
在治疗HCC方面，B-TACE比cTACE消耗更多碘油，且在CR率和ORR方面显示出更好的效果。重要的是，疗效的改善并未伴随着AE的显著增加。基于这些发现，建议开展设计良好的大规模随机对照试验，以进一步验证和拓展这些结果。
本研究已在国际前瞻性系统评价注册库PROSPERO中注册（注册号：CRD42023489055）。
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