Evolution of transarterial chemoembolization-related liver abscess over time: a systematic review and meta-analysis
Yunan Wang1, Hairui Wang1, Zhaoyu Liu1
1Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China.
Background:
Transarterial chemoembolization (TACE) is a primary method for treating malignant liver tumors; however, the occurrence of liver abscesses after TACE has always been a concern. With the evolution of time, TACE techniques and practical experience continue to advance, leading to a deeper understanding of post-TACE liver abscesses. This meta-analysis aimed to comprehensively examine the occurrence of liver abscesses after TACE and focus on its changing trends.
Methods:
Two researchers reviewed the databases of PubMed, Embase, and Web of Science to identify articles that reported liver abscess formation after TACE in patients with hepatic malignant tumor. The search was conducted from the date of establishment of each database up to January 2023. After screening the articles and extracting the data, we used Review Manager 5.3 and Stata 16.0 for analysis and processing.
Results:
This meta-analysis included a total of 32 studies, comprising 254,408 TACE patients, of whom 642 developed liver abscesses after TACE. The pooled incidence rate of liver abscess formation after TACE was 0.54%. The heterogeneity was considerable and significant. Subgroup analysis revealed a significant impact of the evolution of time on the incidence of liver abscess formation after TACE. The incidence was shown to have decreased from 0.61% in the initial 5 years to 0.47% in the most recent 5 years, with statistical significance. Liver metastasis and type 2 biliary abnormality were significantly associated with the development of liver abscess. Mortality directly associated with liver abscess was 7.73% and was gradually decreasing, from over 50% in the 1990s to 5.48% in the past decade, with a statistically significant difference.
Conclusions:
The formation of liver abscess was a relatively low-incidence complication following TACE for malignant liver tumors, with clearly defined risk factors. Moreover, both the incidence and mortality rates of liver abscess were gradually decreasing. These findings provide valuable insights for future clinical practice.
