Meta-analysis: adjusted indirect comparison of drug-eluting bead transarterial chemoembolization versus ⁹⁰Y-radioembolization for hepatocellular carcinoma.

Abstract

To investigate comparative effectiveness of drug-eluting bead transarterial chemoembolization (DEB-TACE) versus Yttrium-90 (⁹⁰Y)-radioembolization for hepatocellular carcinoma (HCC). Studies comparing conventional (c)TACE versus ⁹⁰Y-radioembolization or DEB-TACE for HCC treatment were identified using PubMed/Medline, Embase, and Cochrane databases. The adjusted indirect meta-analytic method for effectiveness comparison of DEB-TACE versus ⁹⁰Y-radioembolization was used. Wilcoxon rank-sum test was used to compare baseline characteristics. A priori defined sensitivity analysis of stratified study subgroups was performed for primary outcome analyses. Publication bias was tested by Egger's and Begg's tests. Fourteen studies comparing DEB-TACE or ⁹⁰Y-radioembolization with cTACE were included. Analysis revealed a 1-year overall survival benefit for DEB-TACE over ⁹⁰Y-radioembolization (79 % vs. 54.8 %; OR: 0.57; 95 %CI: 0.355-0.915; p = 0.02; I-squared: 0 %; p > 0.5), but not for the 2-year (61 % vs. 34 %; OR: 0.65; 95%CI: 0.294-1.437; p = 0.29) and 3-year survival (56.4 % vs. 20.9 %; OR: 0.713; 95 % CI: 0.21-2.548; p = 0.62). There was significant heterogeneity in the 2- and 3-year survival analyses. The pooled median overall survival was longer for DEB-TACE (22.6 vs. 14.7 months). There was no significant difference in tumour response rate. DEB-TACE and ⁹⁰Y-radioembolization are efficacious treatments for patients suffering from HCC; DEB-TACE demonstrated survival benefit at 1-year compared to ⁹⁰Y-radioembolization but direct comparison is warranted for further evaluation. • This meta-analysis shows greater 1-year survival benefit for DEB-TACE over ⁹⁰ Y-radioembolization. • DEB-TACE has a favourable 2- & 3-year survival benefit trend over ⁹⁰ Y-radioembolization. • No significant difference for tumour response was detected. • Direct comparison of these methods for a more robust evaluation is warranted.