Chemoembolization of hepatocellular carcinoma: results of a metaanalysis

Transcatheter arterial chemoembolization is considered the mainstay of therapy for unresectable hepatocellular carcinoma. The purpose of this study was to assess the impact of such treatment on survival by performing a metaanalysis of all available randomized clinical trials comparing this form of therapy to supportive care. A MEDLARS search was conducted covering the years 1970 to 2002. Data analysis was performed according to methods described by Peto. The primary outcome of interest was the proportion of patients surviving 3 and 6 months after treatment. All analyses were performed on an intent-to-treat basis. A literature search yielded 1,100 citations, from which four met protocol-specified inclusion criteria. All studies contained an experimental and control arm totalling 268 patients. The odds ratio for 3- and 6-month survival were 1.31 (95% CI: 0.66-2.58) and 0.91 (95% CI: 0.49-1.68), which was not statistically significant. These data fail to show a survival advantage associated with therapeutic embolization versus supportive care alone in patients with unresectable hepatocellular carcinoma. Existing survival data from randomized controlled trials are of poor quality, and the paucity of patients in these trials eliminates the possibility of drawing meaningful conclusions regarding the effect of chemoembolization on patient survival from these studies.