Meta-analysis: adjusted indirect comparison of drug-eluting bead transarterial chemoembolization versus 90Y-radioembolization for hepatocellular carcinoma
Meta-analysis: adjusted indirect comparison of drug-eluting bead transarterial chemoembolization versus 90Y-radioembolization for hepatocellular carcinoma
复制标题
DOI：
10.1007/s00330-016-4548-3
复制
发表时间：
2017-05-01
影响因子：
5.9
通讯作者：
Kim, Hyun S.
中科院分区：
文献类型：
--
作者：
Ludwig, Johannes M.;Zhang, Di;Kim, Hyun S.
为了研究药物洗脱微珠经动脉化疗栓塞（DEB-TACE）与钇-90（Y-90）放射性栓塞治疗肝细胞癌（HCC）的比较有效性，使用PubMed/Medline、Embase和科克伦数据库确定了比较常规（c）TACE与Y-90放射性栓塞或DEB-TACE治疗HCC的研究。采用经调整的间接荟萃分析方法比较DEB-TACE与Y-90-放射栓塞的有效性。使用Wilcoxon秩和检验比较基线特征。对分层研究亚组进行了先验定义的敏感性分析，用于主要结局分析。通过Egger和Begg检验检验发表偏倚，纳入了14项比较DEB-TACE或Y-90-放射栓塞与cTACE的研究。分析显示，DEB-TACE的1年总生存率优于Y-90-放射栓塞（79% vs. 54.8%; OR：0.57; 95% CI：0.355-0.915; p = 0.02; I-squared：0%; p > 0.5），但2年未进行（61% vs. 34%; OR：0.65; 95%CI：0.294-1.437; p = 0.29）和3年生存率（56.4% vs. 20.9%; OR：0.713; 95%CI：0.21-2.548; p = 0.62）。在2年和3年生存分析中存在显著异质性。DEB-TACE的汇总中位总生存期更长（22.6 vs. 14.7个月）。DEB-TACE和Y-90放射栓塞是治疗肝癌的有效方法;与Y-90放射性栓塞相比，DEB-TACE显示了1年生存率获益，但需要进行直接比较以进行进一步评价。a Euro cent该荟萃分析显示DEB-TACE的1年生存率获益大于（90）Y-放射性栓塞。TACE与（90）Y-放射性栓塞相比，具有有利的2- 3年生存获益趋势。a Euro cent未检测到肿瘤反应的显著差异。a Euro cent直接比较这些方法以进行更可靠的评估是必要的。
To investigate comparative effectiveness of drug-eluting bead transarterial chemoembolization (DEB-TACE) versus Yttrium-90 (Y-90)-radioembolization for hepatocellular carcinoma (HCC).Studies comparing conventional (c)TACE versus Y-90-radioembolization or DEB-TACE for HCC treatment were identified using PubMed/Medline, Embase, and Cochrane databases. The adjusted indirect meta-analytic method for effectiveness comparison of DEB-TACE versus Y-90-radioembolization was used. Wilcoxon rank-sum test was used to compare baseline characteristics. A priori defined sensitivity analysis of stratified study subgroups was performed for primary outcome analyses. Publication bias was tested by Egger's and Begg's tests.Fourteen studies comparing DEB-TACE or Y-90-radioembolization with cTACE were included. Analysis revealed a 1-year overall survival benefit for DEB-TACE over Y-90-radioembolization (79 % vs. 54.8 %; OR: 0.57; 95 %CI: 0.355-0.915; p = 0.02; I-squared: 0 %; p > 0.5), but not for the 2-year (61 % vs. 34 %; OR: 0.65; 95%CI: 0.294-1.437; p = 0.29) and 3-year survival (56.4 % vs. 20.9 %; OR: 0.713; 95 % CI: 0.21-2.548; p = 0.62). There was significant heterogeneity in the 2- and 3-year survival analyses. The pooled median overall survival was longer for DEB-TACE (22.6 vs. 14.7 months). There was no significant difference in tumour response rate.DEB-TACE and Y-90-radioembolization are efficacious treatments for patients suffering from HCC; DEB-TACE demonstrated survival benefit at 1-year compared to Y-90-radioembolization but direct comparison is warranted for further evaluation.aEuro cent This meta-analysis shows greater 1-year survival benefit for DEB-TACE over (90) Y-radioembolization.aEuro cent DEB-TACE has a favourable 2- & 3-year survival benefit trend over (90) Y-radioembolization.aEuro cent No significant difference for tumour response was detected.aEuro cent Direct comparison of these methods for a more robust evaluation is warranted.