Efficacy and complications of transarterial chemoembolization alone or in combination with different protocols for hepatocellular carcinoma: A Bayesian network meta-analysis of randomized controlled trials

Background and aims:Transarterial chemoembolization(TACE)is the standard treatment for most intermediate-toadvanced stage hepatocellular carcinoma.With the ongoing development of interventional therapies,TACE in combination with different protocols is being explored.A network meta-analysis to collect recent evidence in this field is required.Methods:We searched PubMed,Web of Science,Cochrane Central Register of Controlled Trials,Embase,Chinese National Knowledge Infrastructure database,Cochrane Library,and Wanfang database from their inception to May 2022 for randomized controlled trials(RCTs)that reported TACE in combination with different protocols for hepatocellular carcinoma.Results:In total,67 RCTs assessing eight combination treatments were included.The quality of primary outcomes was from moderate to low.The Bayesian network meta-analysis confirmed that TACE combined with iodine-125 seed implantation had the highest probability of 1-year survival rate and TACE combined with sorafenib had the highest probability of 2-year survival rate.TACE alone had the highest probability of incidence of fever,TACE combined with sorafenib had the highest probability of incidence of pain and TACE combined with percutaneous ethanol injection had the highest probability of incidence of nausea and vomiting.Conclusion:This Bayesian network meta-analysis found that TACE combined with iodine-125 seed and TACE combined with sorafenib may benefit patients in terms of 1-year survival and 2-year survival,respectively.To confirm this conclusion,high-quality and well-designed RCTs with a larger sample size are needed.