PMID- 38453011
OWN - NLM
STAT- MEDLINE
DCOM- 20240408
LR  - 20240408
IS  - 2210-741X (Electronic)
IS  - 2210-7401 (Linking)
VI  - 48
IP  - 4
DP  - 2024 Apr
TI  - Efficacy and safety of drug-eluting bead transarterial chemoembolization 
      (DEB-TACE) combined with tyrosine kinase inhibitors (TKIs) in patients with 
      unresectable hepatocellular carcinoma (uHCC): A systematic review and 
      meta-analysis.
PG  - 102313
LID - S2210-7401(24)00034-2 [pii]
LID - 10.1016/j.clinre.2024.102313 [doi]
AB  - BACKGROUND: The optimal management of unresectable hepatocellular carcinoma 
      (uHCC) remains an unresolved challenge. There is ongoing debate regarding the 
      efficacy and safety of drug-eluting bead TACE (DEB-TACE) with tyrosine kinase 
      inhibitors (TKIs). METHODS: We searched PubMed, Embase, Web of Science and the 
      Cochrane Library for eligible studies. The main endpoints under investigation 
      were survival outcomes, including overall survival (OS), progression-free 
      survival (PFS), and time to progression (TTP). Secondary outcomes encompassed 
      tumor response rates and adverse events (AEs). Two researchers conducted the data 
      extraction independently and assessed the quality of the studies. After pooling 
      and analyzing the data, we assessed the heterogeneity and performed both subgroup 
      analysis and sensitivity analysis. Additionally, we evaluated the potential for 
      publication bias. RESULTS: Eight studies with 1513 patients were finally 
      retrieved. Compared to monotherapy, although bigeminal therapy exhibited improved 
      survival benefits (OS: HR: 0.56, 95 % CI 0.41-0.76, p < 0.001; TTP: HR: 0.72, 95 
      % CI 0.59-0.87, p = 0.001) and tumor response (ORR: RR: 1.59; 95 % CI 1.19-2.13, 
      p = 0.002; DCR: RR: 1.14; 95 % CI 1.03-1.26, p = 0.010), the reliability of 
      results was affected by significant heterogeneity. In the subgroup analysis, 
      compared to DEB-TACE alone, the bigeminal therapy failed to show any statistical 
      differences. Compared to TKIs, it demonstrated significant advantages in both 
      survival (OS: HR: 0.49, 95 % CI 0.40-0.61, p < 0.001; TTP: HR: 0.60, 95 % CI 
      0.48-0.75, p < 0.001) and tumor response (ORR: RR: 2.40, 95 % CI 1.86-3.09, p < 
      0.001; DCR: RR: 1.36, 95 % CI 1.20-1.54, p < 0.001) while low heterogeneity was 
      observed. Concerning safety, DEB-TACE provides no more severe AEs while 
      TKIs-related AEs require close monitoring. CONCLUSION: Our findings suggest that 
      DEB-TACE combined with TKIs may be a safe and effective treatment for uHCC, which 
      is more suitable for patients in the advanced stage.
CI  - Copyright (c) 2024 Elsevier Masson SAS. All rights reserved.
FAU - Ji, Jun
AU  - Ji J
AD  - Division of Liver Surgery, Department of General Surgery, West China Hospital, 
      Sichuan University, Chengdu 610041, China.
FAU - Zhang, Zhihong
AU  - Zhang Z
AD  - Division of Liver Surgery, Department of General Surgery, West China Hospital, 
      Sichuan University, Chengdu 610041, China.
FAU - Hou, Ziqi
AU  - Hou Z
AD  - Division of Liver Surgery, Department of General Surgery, West China Hospital, 
      Sichuan University, Chengdu 610041, China.
FAU - Qiu, Guoteng
AU  - Qiu G
AD  - Division of Liver Surgery, Department of General Surgery, West China Hospital, 
      Sichuan University, Chengdu 610041, China.
FAU - Mi, Shizheng
AU  - Mi S
AD  - Division of Liver Surgery, Department of General Surgery, West China Hospital, 
      Sichuan University, Chengdu 610041, China.
FAU - Jin, Zhaoxing
AU  - Jin Z
AD  - Division of Liver Surgery, Department of General Surgery, West China Hospital, 
      Sichuan University, Chengdu 610041, China.
FAU - Huang, Jiwei
AU  - Huang J
AD  - Division of Liver Surgery, Department of General Surgery, West China Hospital, 
      Sichuan University, Chengdu 610041, China. Electronic address: 
      huangjiwei@wchscu.cn.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20240305
PL  - France
TA  - Clin Res Hepatol Gastroenterol
JT  - Clinics and research in hepatology and gastroenterology
JID - 101553659
RN  - 0 (Tyrosine Kinase Inhibitors)
SB  - IM
MH  - Humans
MH  - *Carcinoma, Hepatocellular/pathology
MH  - *Liver Neoplasms/drug therapy
MH  - Tyrosine Kinase Inhibitors
MH  - Reproducibility of Results
MH  - *Chemoembolization, Therapeutic/adverse effects
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Meta-analysis
OT  - Transarterial chemoembolization
OT  - Tyrosine kinase inhibitors
OT  - Unresectable hepatocellular carcinoma
COIS- Declaration of competing interest The authors declare that they have no known 
      competing financial interests or personal relationships that could have appeared 
      to influence the work reported in this paper.
EDAT- 2024/03/08 00:43
MHDA- 2024/04/08 06:43
CRDT- 2024/03/07 19:18
PHST- 2024/01/15 00:00 [received]
PHST- 2024/02/22 00:00 [revised]
PHST- 2024/03/01 00:00 [accepted]
PHST- 2024/04/08 06:43 [medline]
PHST- 2024/03/08 00:43 [pubmed]
PHST- 2024/03/07 19:18 [entrez]
AID - S2210-7401(24)00034-2 [pii]
AID - 10.1016/j.clinre.2024.102313 [doi]
PST - ppublish
SO  - Clin Res Hepatol Gastroenterol. 2024 Apr;48(4):102313. doi: 
      10.1016/j.clinre.2024.102313. Epub 2024 Mar 5.