Review ArticleDrug-eluting beads versus conventional chemoembolization for the treatment of unresectable hepatocellular carcinoma: A meta-analysis

BackgroundDespite the promising results of earlier studies, a clear superiority of drug-eluting beads transarterial chemoembolization over conventional chemoembolization in unresectable hepatocellular carcinoma patients has not been established yet.AimsTo evaluate the efficacy and safety of the two treatments in unresectable hepatocellular carcinoma patients.MethodsComputerized bibliographic search on the main databases was performed. One-year, two-year, three-year survival rates were analyzed. Hazard ratios from Kaplan-Meier curves were extracted in order to perform an unbiased comparison of survival estimates. Objective response and severe adverse event rate were analyzed too.ResultsFour randomized-controlled trials and 8 observational studies with 1449 patients were included in the meta-analysis. Non-significant trends in favor of drug-eluting beads chemoembolization were observed as for 1-year (odds ratio: 0.76, 0.48-1.21, p = 0.25), 2-year (odds ratio: 0.68, 0.42-1.12, p = 0.13) and 3-year survival (odds ratio: 0.57, 0.32-1.01, p = 0.06). Meta-analysis of plotted hazard ratios confirmed this trend (hazard ratio: 0.86, 0.71-1.03, p = 0.10). Pooled data of objective response showed no significant difference between the two treatments (odds ratio: 1.21, 0.69-2.12, p = 0.51). No statistically significant difference in adverse events was registered (odds ratio: 0.85, 0.60-1.20, p = 0.36).ConclusionsOur results stand for a non-superiority of drug-eluting beads chemoembolization with respect to conventional chemoembolization in hepatocarcinoma patients.