Journal Article

Balloon-occluded versus conventional transarterial chemoembolization for the treatment of early to intermediate stage hepatocellular carcinoma: a meta-analysis and trial sequential analysis

Wang, Weiwei, Ma, Yanan, Shao, Haibo, Zhai, Huan, Liu, Jiaxi, You, Qiwen

2025

Overview

Background We performed a meta-analysis and trial sequential analysis (TSA) to compare the therapeutic efficacy and adverse events (AEs) of balloon-occluded transarterial chemoembolization (B-TACE) with conventional transarterial chemoembolization (cTACE) in treating early-to-intermediate-stage hepatocellular carcinoma (HCC). Methods We systematically searched PubMed, Web of Science, Cochrane Library, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang databases for studies comparing B-TACE and cTACE in the treatment of HCC. The outcomes included the complete response (CR) rate, objective response rate (ORR), lipiodol consumption, and adverse events (AEs). Depending on the heterogeneity assessment, either a fixed-effects or random-effects model was utilized, followed by a meta-analysis using Review Manager 5.3. Additionally, a TSA was conducted to assess the adequacy of the sample size. Results Five studies including a total of 1166 patients were analyzed. This meta-analysis revealed that compared with cTACE, B-TACE significantly improved the CR rate (risk ratio [RR] = 1.21, 95% confidence interval [CI] 1.04–1.42, p  = 0.02) and the ORR (RR = 1.23, 95% CI 1.09–1.38, p  = 0.0006). These findings were validated using TSA, which did not require a larger information size. The TSA results indicated that B-TACE consumed more lipiodol than cTACE, potentially leading to more satisfactory embolization efficacy. In terms of AEs, only post-embolization syndrome was found to occur more frequently in patients treated with B-TACE than in those treated with cTACE (RR = 1.30, 95% CI 1.01–1.68, p  = 0.04). However, the TSA suggested that additional cases are necessary to confirm this difference. Conclusions B-TACE consumed more lipiodol and demonstrated superior effects on the CR rate and ORR compared to cTACE in the treatment of HCC. Importantly, this improvement in efficacy did not correspond to a significant increase in AEs. Based on these findings, it is recommended that well-designed, large-scale randomized controlled trials be conducted to further validate and expand upon these results. Trial registration This study was registered in the international prospective register of systematic reviews PROSPERO (registration No: CRD42023489055).

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Analysis / Balloon Occlusion - adverse effects / Balloon Occlusion - methods / Balloon treatment / Balloon-occluded transarterial chemoembolization / Biomedical and Life Sciences / Biomedicine / Cancer Research / Cancer therapies / Carcinoma, Hepatocellular - pathology / Carcinoma, Hepatocellular - therapy / Care and treatment / Catheters / Chemoembolization / Chemoembolization, Therapeutic - adverse effects / Chemoembolization, Therapeutic - methods / Clinical trials / Cohort analysis / Conventional transarterial chemoembolization / CT imaging / Diagnosis / Drug dosages / Embolization / Ethiodized Oil - administration & dosage / Health aspects / Health Promotion and Disease Prevention / Hepatocellular carcinoma / Hepatoma / Humans / Liver cancer / Liver Neoplasms - pathology / Liver Neoplasms - therapy / Medical research / Medicine, Experimental / Medicine/Public Health / Meta-analysis / Neoplasm Staging / Oncology / Patient outcomes / Risk factors / Surgical Oncology / Systematic Review / Therapeutic chemoembolization / Treatment Outcome / Trial sequential analysis / Tumors / Veins & arteries