DSM-TACE Versus Conventional Approaches in HCC: A Systematic Review and Meta-Analysis.

Purpose: To perform a systematic review and meta-analysis comparing efficacy and the safety profile of Degradable Starch Microspheres TACE (DSM-TACE) with conventional treatments (cTACE and DEB-TACE) in patients with Hepatocellular carcinoma (HCC). Materials and Methods: Comparative studies (including randomized controlled trials -RCTs- and observational studies) reporting at least one of the following outcomes were included and considered for statistical analysis: Tumor response according to mRECIST criteria, Overall Survival (OS), Adverse Events (AEs), increase of ALT and AST levels. Risk Ratios were calculated using random-effects models. Survival analyses and Hazard Ratios were derived using reconstructed individual patient data. Results: 6/180 articles met inclusion criteria, including 1 RCT and 5 observational studies. Tumor response was comparable between DSM-TACE and control groups, without significant differences in the pooled analyses. DSM-TACE was not associated with a significant improvement in OS compared with conventional treatments (HR = 1.04; 95% CI: 0.73–1.49; p = 0.690). AEs were only assessed narratively, due to insufficient homogeneous data for a pooled quantitative analysis. Restricting the analysis to DSM-TACE and cTACE, the analyses of post-procedural ALT and AST levels suggested a trend toward lower enzyme elevations with DSM-TACE (ALT: β=30.3, p=0.163; AST: β=44.3, p=0.141), although differences were not statistically significant. Conclusion: DSM-TACE demonstrates radiological efficacy and an OS comparable to conventional treatments, with a trend toward a more favorable safety profile. DSM-TACE may represent an exploratory option within a personalized therapeutic strategy, although statistical significance was not demonstrated. Further well-designed clinical trials are required to better define its clinical role. © Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2026.