Comparing the safety and efficacy of small-versus medium-size particles in drug-eluting bead chemoembolization for hepatocellular carcinoma: A meta-analysis.

e16335 Background: The optimal microparticle size for drug-eluting beads transarterial chemoembolization (DEB-TACE) remains unknown. Studies have shown that using smaller particle sizes may result in fewer adverse events, however, comparative data between particle sizes are limited. This meta-analysis aimed to compare the efficacy and safety of DEB-TACE using 100-300 μm versus 300-500 μm CalliSpheres microspheres (CSMs) for treating multiple hepatocellular carcinoma (HCC). Methods: We systematically searched PubMed and clinicaltrials.gov for articles published between 2000 and 2023 providing data regarding the use of DEB-TACE using 100-300 μm and 300-500 μm size microspheres for treating HCC with data on treatment response, liver function tests, and complications available. Mantel-Haenszel method was used to assess the pooled odds ratio value at a 95% confidence interval (CI) for dichotomous variables and forest plots were created using RevMan for analysis. P < 0.05 was considered to be significant. Results: An analysis of 5 studies demonstrated that DEB-TACE of 300-500 μm size particle was associated with a significantly higher partial response (PR) rate at 1 month (OR: 0.31, 95% CI: 0.11-0.85, p = 0.02). A non-significant trend favoring DEB-TACE 100-300 μm in achieving complete response (CR) at 1 month (OR: 1.77, 95% CI: 0.89-3.54, p = 0.10) and 6 months (OR: 4.64, 95% CI: 0.72-29.89, p = 0.11) was seen. No statistically significant differences were observed in the rates of stable or progressive disease between the two groups at any time. Regarding safety, DEB-TACE 300-500 μm size exhibited a trend towards an increased risk of liver abscess formation (OR: 8.00, 95% CI: 0.92-69.51, p = 0.08). Liver function parameters, including alanine aminotransferase (ALT) and alkaline phosphatase (ALP), demonstrated a non-significant trend toward higher levels in the DEB 300-500 μm cohort. The incidence of adverse events, including postembolization syndrome, fever, and nausea/vomiting, was comparable across both groups (p > 0.05). Conclusions: The findings suggest that while DEB 100-300 μm size may offer a potential advantage in achieving tumor response, DEB 300-500 μm size is associated with a greater likelihood of partial response but an elevated risk of complications. Further prospective studies are warranted to validate these findings and inform optimal treatment strategies.