Outcomes of Transarterial Embolisation (TAE) vs. Transarterial Chemoembolisation (TACE) for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Simple Summary Non-surgical management of hepatocellular carcinoma (HCC) is used for selected patients. Of these management options, transarterial embolisation (TAE) and transarterial chemoembolisation (TACE) are the two main locoregional treatment options. There was no difference in OS among patients treated with TACE/TAE, single versus repeat treatments. Post-procedural adverse effects were higher in the TACE group but were not statistically significant. TACE has a comparable long-term survival and complications profile to TAE for patients with HCC. However, the low-to-moderate quality of current RCTs warrants high-quality RCTs, which are necessary to provide enough evidence to give a definitive answer and inform treatment plans for the future. Abstract Although hepatocellular carcinoma is increasingly common, debate exists surrounding the management of patients with unresectable disease comparing transarterial embolisation (TAE) or transarterial chemoembolisation (TACE). This study aimed to compare the outcomes of patients receiving TAE and TACE. A systematic review was performed using PubMed, Medline, Embase, and Cochrane databases to identify randomised controlled trials (RCTs) until August 2021. The primary outcome was overall survival (OS) and the secondary outcomes were progression-free survival (PFS) and adverse events. Five studies with 609 patients were included in the analysis. There was no statistically significant difference in the OS (p = 0.36) and PFS (p = 0.81). There was no difference in OS among patients treated with a single TACE/TAE versus repeat treatments. Post-procedural adverse effects were higher in the TACE group but were not statistically significant. TACE has comparable long-term survival and complications profile to TAE for patients with HCC. However, the low-to-moderate quality of current RCTs warrants high-quality RCTs are necessary to provide enough evidence to give a definitive answer and inform treatment plans for the future.

[1]  A. Granito,et al.  TKIs in combination with immunotherapy for hepatocellular carcinoma , 2023, Expert review of anticancer therapy.

[2]  M. Viedma-Martínez,et al.  Skin Necrosis after Transarterial Chemoembolization. , 2022, New England Journal of Medicine.

[3]  P. Sidaway.  HAIC-FO improves outcomes in HCC , 2022, Nature Reviews Clinical Oncology.

[4]  F. Piscaglia,et al.  TRANS-TACE: Prognostic Role of the Transient Hypertransaminasemia after Conventional Chemoembolization for Hepatocellular Carcinoma , 2021, Journal of personalized medicine.

[5]  Lin-Feng Xu,et al.  Comparison of initial tumor responses to transarterial bland embolization and drug-eluting beads-transarterial chemoembolization in the management of hepatocellular carcinoma: a propensity-score matching analysis. , 2021, Journal of Gastrointestinal Oncology.

[6]  F. Piscaglia,et al.  Experience with regorafenib in the treatment of hepatocellular carcinoma , 2021, Therapeutic advances in gastroenterology.

[7]  H. Reeves,et al.  Treatment strategies for early stage hepatocellular carcinoma: a systematic review and network meta-analysis of randomised clinical trials. , 2020, HPB : the official journal of the International Hepato Pancreato Biliary Association.

[8]  E. Griffiths,et al.  Critical Appraisal of the Impact of Oesophageal Stents in the Management of Oesophageal Anastomotic Leaks and Benign Oesophageal Perforations: An Updated Systematic Review , 2019, World Journal of Surgery.

[9]  Y. Pomyen,et al.  Gene signature predictive of hepatocellular carcinoma patient response to transarterial chemoembolization , 2019, International journal of biological sciences.

[10]  Yan-hui Wu,et al.  Radiological appearance of hepatocellular carcinoma predicts the response to trans-arterial chemoembolization in patients undergoing liver transplantation , 2019, BMC Cancer.

[11]  Prashanth Rawla,et al.  Update in global trends and aetiology of hepatocellular carcinoma , 2018, Contemporary oncology.

[12]  T. Frankel,et al.  Critical evaluation of the American Joint Commission on Cancer (AJCC) 8th edition staging system for patients with Hepatocellular Carcinoma (HCC): A Surveillance, Epidemiology, End Results (SEER) analysis , 2018, Journal of surgical oncology.

[13]  Alan D. Lopez,et al.  The Burden of Primary Liver Cancer and Underlying Etiologies From 1990 to 2015 at the Global, Regional, and National Level , 2017, JAMA oncology.

[14]  F. Piscaglia,et al.  Transarterial chemoembolization vs bland embolization in hepatocellular carcinoma: A meta-analysis of randomized trials , 2017, United European gastroenterology journal.

[15]  L. Schwartz,et al.  Randomized Trial of Hepatic Artery Embolization for Hepatocellular Carcinoma Using Doxorubicin-Eluting Microspheres Compared With Embolization With Microspheres Alone. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[16]  R. Lencioni,et al.  Lipiodol transarterial chemoembolization for hepatocellular carcinoma: A systematic review of efficacy and safety data , 2016, Hepatology.

[17]  A. Facciorusso,et al.  Drug-eluting beads versus conventional chemoembolization for the treatment of unresectable hepatocellular carcinoma: A meta-analysis. , 2016, Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver.

[18]  L. Mariani,et al.  Drug‐eluting beads versus conventional chemoembolization for the treatment of unresectable hepatocellular carcinoma , 2016, Journal of gastroenterology and hepatology.

[19]  S. Ye,et al.  Imbalance in systemic inflammation and immune response following transarterial chemoembolization potentially increases metastatic risk in huge hepatocellular carcinoma , 2015, Tumor Biology.

[20]  Yibing Chen,et al.  Transarterial chemoembolization aggravated peritumoral fibrosis via hypoxia‐inducible factor‐1α dependent pathway in hepatocellular carcinoma , 2015, Journal of gastroenterology and hepatology.

[21]  B. Sangro,et al.  Transarterial Chemoembolization and Radioembolization , 2014, Seminars in Liver Disease.

[22]  M. Barone,et al.  Are hematopoietic stem cells involved in hepatocarcinogenesis? , 2014, Hepatobiliary surgery and nutrition.

[23]  Mark Loeb,et al.  Newcastle-Ottawa Scale: comparing reviewers’ to authors’ assessments , 2014, BMC Medical Research Methodology.

[24]  A. Burroughs,et al.  Transarterial chemoembolization and bland embolization for hepatocellular carcinoma. , 2014, World journal of gastroenterology.

[25]  A. Burroughs,et al.  A randomised phase II/III trial of 3-weekly cisplatin-based sequential transarterial chemoembolisation vs embolisation alone for hepatocellular carcinoma , 2013, British Journal of Cancer.

[26]  I. Ng,et al.  Does the hepatitis B antigen HBx promote the appearance of liver cancer stem cells? , 2011, Cancer research.

[27]  A. Stang.  Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses , 2010, European Journal of Epidemiology.

[28]  Anastasia Pomoni,et al.  Prospective Randomized Comparison of Chemoembolization with Doxorubicin-Eluting Beads and Bland Embolization with BeadBlock for Hepatocellular Carcinoma , 2010, CardioVascular and Interventional Radiology.

[29]  J. Ioannidis,et al.  The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration , 2009, BMJ : British Medical Journal.

[30]  W. Hsu,et al.  Expression of Hypoxia-Inducible Factor (HIF)-1α and Vascular Endothelial Growth Factor (VEGF)-D As Outcome Predictors in Resected Esophageal Squamous Cell Carcinoma , 2008, Disease markers.

[31]  Ramon Planas,et al.  Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial , 2002, The Lancet.

[32]  Chien-Fang Yang,et al.  Transcatheter arterial embolization with or without cisplatin treatment of hepatocellular carcinoma. A randomized controlled study , 1994, Cancer.

[33]  M. Kusano,et al.  Prospective and randomized clinical trial for the treatment of hepatocellular carcinoma — a comparison of lipiodol-transcatheter arterial embolization with and without Adriamycin (first cooperative study) , 2004, Cancer Chemotherapy and Pharmacology.