Tumor Biology

, Volume 35, Issue 9, pp 8451–8459 | Cite as

Transarterial embolization with or without chemotherapy for advanced hepatocellular carcinoma: a systematic review

  • Zhi-Bo Xie
  • Liang Ma
  • Xiao-Bo Wang
  • Tao Bai
  • Jia-Zhou Ye
  • Jian-Hong Zhong
  • Le-Qun Li


Transarterial chemoembolization (TACE) and transarterial embolization (TAE) are commonly used as first-line treatment for patients with advanced hepatocellular carcinoma (HCC) and have been shown to improve overall survival (OS). However, there remain concerns regarding whether the benefit of the prolonged survival achieved with TACE is superior to the maximum cytotoxic effect of the associated chemotherapeutics. This systematic review aims to compare the efficiency of TACE and TAE based on randomized controlled trials (RCTs). MEDLINE, EMBASE, the Cochrane library, the Science Citation Index, and the Chinese National Knowledge Infrastructure databases were systematically searched through the end of April 2014. Risk ratios (RRs) and 95 % confidence intervals (CIs) were calculated. Meta-analysis of the RCTs was conducted to estimate the mortality and survival rate between the TACE and TAE groups. The analysis included five RCTs involving 582 patients. For all-cause mortality, TACE did not result in a statistically significant reduced incidence of adverse events than TAE with a pooled RR of 1.21 (95 % CI = 0.74–1.98, P = 0.16). In addition, 6-, 9-, 12-, 24-, and 36-month OS of the TACE group were not significantly higher than that of the TAE group (all P > 0.05). Interestingly, TACE resulted in a significantly higher rate of advanced events. The efficacy of TACE is not superior to TAE in advanced HCC patients. Moreover, TACE was associated with an increased rate of adverse events than TAE. Improved strategies are needed to reduce the risk of post-TACE complications.


Advanced Hepatocellular carcinoma Meta-analysis Transarterial embolization Transarterial chemoembolization 



This work was supported by the Self-Raised Scientific Research Fund of the Ministry of Health of Guangxi Province (No. Z2012345 and Z2014241) and Youth Science Foundation of Guangxi Medical University (No: GXMUYSF201302)to ZJH and Guangxi Natural Science Foundation (No. 2011GXNSFD018032) and HCC Bridge Study (No. CA182023) to LLQ.

Conflicts of interest


Supplementary material

13277_2014_2340_MOESM1_ESM.doc (98 kb)
Supplement 1 (DOC 97 kb)
13277_2014_2340_MOESM2_ESM.doc (48 kb)
Supplement 2 (DOC 48 kb)
13277_2014_2340_MOESM3_ESM.doc (30 kb)
Supplement 3 (DOC 29 kb)
13277_2014_2340_MOESM4_ESM.doc (64 kb)
Checklist S1 (DOC 63 kb)


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Copyright information

© International Society of Oncology and BioMarkers (ISOBM) 2014

Authors and Affiliations

  1. 1.Hepatobiliary Surgery DepartmentAffiliated Tumor Hospital of Guangxi Medical UniversityNanningPeople’s Republic of China

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