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Thématique :
- Carcinome hépatocellulaire (CHC)
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Sylvain MANFREDI
Coup de coeur :
 
 
Digestive and Liver Disease
  2016/05  
 
  2016 Jun;48(6):571-7  
  doi: 10.1016/j.dld.2016.02.005  
 
  Drug-eluting beads versus conventional chemoembolization for the treatment of unresectable hepatocellular carcinoma: A meta-analysis.  
 
  Antonio Facciorusso , Marianna Di Maso, Nicola Muscatiello.  
  http://www.ncbi.nlm.nih.gov/pubmed/?term=Drug-eluting+beads+versus+conventional+chemoembolization+for+the+treatment+of+unresectable+hepatocellular+carcinoma%3A+A+meta-analysis  
 
 

BACKGROUND:

Despite 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.

AIMS:

To evaluate the efficacy and safety of the two treatments in unresectable hepatocellular carcinoma patients.

METHODS:

Computerized 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.

RESULTS:

Four 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).

CONCLUSIONS:

Our results stand for a non-superiority of drug-eluting beads chemoembolization with respect to conventional chemoembolization in hepatocarcinoma patients.

 
Question posée
 
Supériorité de l’embolisation avec microbilles par rapport à la chimio-embolisation traditionnelle, pour le CHC non résécable ?
 
Question posée
 
Méta-analyse de 4 essais randomisés et 8 études observationnelles, sur près de 1500 patients, concluant à l’absence de supériorité d’une technique sur l’autre.
 
Commentaires

Analyse globale. Une analyse des différents sous-groupes en fonction notamment de la taille des tumeurs est nécessaire.

 
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