Dados do Trabalho

Título

Transarterial Chemoembolization for Hepatocellular Carcinoma in Patients with Transjugular Intrahepatic Portosystemic Shunt: A Single-Arm Systematic Review and Meta-Analysis

Introdução

Transarterial chemoembolization (TACE) is a common treatment for hepatocellular carcinoma (HCC). However, in patients with a transjugular intrahepatic portosystemic shunt (TIPS), the efficacy of TACE remains debated.

Objetivo

This meta-analysis aims to evaluate the efficacy of TACE in patients with HCC who have undergone TIPS, focusing on tumor response.

Método

This study conducted a comprehensive search of PubMed, Embase, Cochrane Library, and Web of Science to identify clinical studies evaluating the efficacy of conventional TACE in patients with HCC who had undergone TIPS using the following search: (“hepatocellular carcinoma” OR “hepatocellular carcinomas” OR “HCC”) and (“transjugular intrahepatic portosystemic shunt” or “TIPS”) and (“transarterial chemoembolization” OR “TACE” OR “conventional transarterial chemoembolization” OR “cTACE”). Clinical studies written in English that involved at least 10 patients were included. A meta-analysis was then performed to generate pooled estimates for tumor control, defined as the sum of complete response (CR), partial response (PR), and stable disease (SD) occurrences, based on the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Tumor progression was directly assessed through the occurrence of progressive disease (PD) as defined by the same criteria.

Resultados

Initially, 230 records were identified, of which 104 were unique. After preliminary selection based on titles and abstracts, 17 reports were selected for further evaluation. Ultimately, eight studies were included in the final analysis, encompassing a total of 390 patients. In the quantitative synthesis, the pooled proportion of patients achieving tumor control was 79% (95% CI: 66-93%; I² = 94%) using a random effects model, indicating a predominantly favorable response to TACE. Additionally, the pooled progression rate was 20% (95% CI: 8-33%; I² = 93%), reflecting a relatively low rate of disease progression.

Conclusão

TACE appears to be an effective treatment for HCC in patients with TIPS, as demonstrated by a high overall response rate and relatively low rate of disease progression. However, the significant heterogeneity observed among the included studies suggests that further research is necessary to better understand the variability in patient outcomes.