Efficacy and safety of irreversible electroporation for malignant liver tumors: a systematic review and meta-analysis

Abstract

Objective The data regarding overall survival (OS) and progression-free survival (PFS) following irreversible electroporation (IRE) is scarce. We performed a systematic review of the safety and efficacy of IRE for liver malignancies. Methods Searches of MEDLINE, EMBASE, and SCOPUS databases were performed through September 1, 2019. Studies reporting the survival data (OS and PFS) and complications (graded according to the Society of interventional Radiology classification) were included. A generalized linear mixed method with a random-effects model was used for assessing pooled incidence rates and corresponding 95% confidence intervals (CIs). Results A total of 25 studies (n = 776, 15 prospective, 10 retrospective) were included. Metastasis, hepatocellular carcinoma, and cholangiocarcinoma were present in 354, 285, and 100 patients, respectively. The pooled OS at 6, 12, 24, and 36 months was 93.28% (95% CI: 63.23–99.12, I²= 67%), 81.29% (95% CI: 69.80–89.22, I² = 73%), 61.47% (95% CI: 52.81–69.46, I² = 0%), and 40.88% (95% CI: 28.43–54.61, I² = 64%), respectively. The pooled PFS at 6, 12, and 24 months was 79.72% (95% CI: 67.88–87.97, I² = 70%), 64.19% (95% CI: 56.68–71.06, I² = 57%), 49.05% (95% CI: 11.47–87.73, I² = 96%), respectively. Overall complication rate was 23.7%. Major complications (grade C-F) occurred in 6.9% patients. Conclusion IRE is associated with favorable OS and PFS. Although the overall complication rate is high, most complications are graded as minor. Key Points • The pooled OS and PFS at 6, 12, and 24 months for all the tumor types was 93.28% and 79.72%, 81.29% and 64.19%, and 61.47% and 49.05%, respectively. • HCC was associated with a better OS at 12 and 36 months. • The overall complication rate was 23.7%, with major complications (SIR grade C-F) comprising 6.9%.