Dados do Trabalho

Título

Drug-Eluting Beads Versus Conventional Transarterial Chemoembolization for Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: a Systematic Review and Meta-Analysis

Introdução

Drug-eluting bead transarterial chemoembolization (DEB-TACE) has demonstrated efficacy in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). However, its potential superiority over conventional TACE (cTACE) remains a subject of ongoing investigation.

Objetivo

Compare the efficacy between DEB-TACE and cTACE for HCC patients with PVTT.

Método

A comprehensive search was done using Pubmed, Embase, Cochrane Library, and Web of Science databases in order to find any clinical studies that evaluated the efficacy of DEB-TACE compared to cTACE in patients with HCC and PVTT. Clinical studies written in English that had at least 10 patients were included. Then, a meta-analysis was conducted to find risk ratios (RRs) for tumor control — which was done through the sum of complete response (CR), partial response (PR), and stable disease (SD) occurrences, according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) —, and tumor worsening — calculated directly through progressive disease (PD) occurrence. Furthermore, an overall survival (OS) hazard ratio (HR) was obtained.

Resultados

385 studies were initially found. Of these, 257 were unique entries. Per our exclusion and inclusion criteria, 253 articles were removed by title or abstract. After full text analysis of the remaining four entries, three articles were finally selected, amounting to 119 and 213 patients in the DEB-TACE group and cTACE group, respectively. Under the random effects model, these interventions were not significantly different for tumor control, even though it favored DEB-TACE (RR = 1.18; 95% CI: 0.91-1.53; I² = 59%), following a congruent RR of 0.52 (95% CI: 0.31-0.89; I² = 0%) for tumor worsening that significantly favors DEB-TACE. However, under the common effects model, tumor control was marginally significant in favor of DEB-TACE (RR = 1.16; 95% CI: 1.03-1.31), while for tumor worsening the results were very similar (RR = 0.52; 95% CI: 0.31-0.89). Moreover, DEB-TACE also had a more favorable result for OS under both common effect (HR = 1.61; 95% CI: 1.25-2.06; I² = 26%) and random effects (HR = 1.62; 95% CI: 1.24-2.12) models.

Conclusão

DEB-TACE overall showed to be a better treatment for HCC patients with PVTT. Nevertheless, more standardized studies with a greater number of patients are needed for stronger conclusions to be made, especially with the more complex context of a patient with PVTT.