Open Access

ARTICLE

Efficacy and Safety of Transcatheter Arterial Chemoembolization and Transcatheter Arterial Chemotherapy Infusion in Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Xinyang Liu^*1, Zhichao Wang^*1, Zongwei Chen^†1, Longzi Liu^*, Lijie Ma^*, Liangqing Dong^*, Zhao Zhang^*, Shu Zhang^*, Liuxiao Yang^*, Jieyi Shi^*, Jia Fan^*‡, Xiaoying Wang^*, Qiang Gao^*‡

* Department of Liver Surgery, Liver Cancer Institute, Zhongshan Hospital, and Key Laboratory of Carcinogenesis and Cancer Invasion (Ministry of Education), Fudan University, Shanghai, P.R. China
† Department of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
‡ State Key Laboratory of Genetic Engineering, Fudan University, Shanghai, P.R. China
1 These authors provided equal contribution to this work and are co-first authors.

Oncology Research 2018, 26(2), 231-239. https://doi.org/10.3727/096504017X15051752095738

Abstract

Hepatocellular carcinoma (HCC) is a worldwide health threat with increasing incidence and a high mortality rate. Most HCC patients are diagnosed at an advanced stage and are unable to undergo potential curative surgery. Transcatheter arterial chemoembolization (TACE) and transcatheter arterial chemotherapy infusion (TACI) are two of the main palliative treatments for advanced HCC patients. The clinical efficacy and safety of TACE and TACI are controversial. For this reason, we conducted a systematic review and meta-analysis to summarize the current evidence. We searched for randomized controlled trials (RCTs) and cohort studies that compared the clinical outcomes and adverse effects in HCC patients who received TACE or TACI treatments. The database search was performed and last updated on November 1, 2016. Overall survival and clinical response were compared using a hazard ratio (HR) with a 95% confidence interval (CI). A total of 11 clinical studies that included 13,090 patients were included based on the inclusion/exclusion criteria, of which 9 were cohort studies and 2 were RCTs. TACE was associated with a 23% lower hazard of death compared to TACI (pooled HR = 0.77, 95% CI = 0.67–0.88, p = 0.0002). Patients receiving TACE had a 28% higher disease control rate (DCR) and 162% higher objective response rate (ORR). Only the increase in ORR associated with TACE was statistically significant [DCR: odds ratio (OR) = 1.28, 95% CI = 0.35–4.64, p = 0.71; ORR: OR = 2.62, 95% CI = 1.33–5.15, p = 0.002]. TACE is associated with more favorable survival and response rate than TACI in patients with intermediate or advanced HCC.

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