Analysis of risk factors for post-transarterial chemoembolization syndrome in patients with liver cancer: a systematic review protocol.

BACKGROUND: Transarterial chemoembolization (TACE) is the standard treatment for patients with early-stage hepatocellular carcinoma (HCC), and post-embolization syndrome frequently occurs after the procedure. Although multiple studies have investigated risk factors for PES in HCC patients after TACE, their findings remain inconsistent and controversial. This systematic review aims to synthesize current evidence and identify risk factors associated with PES in HCC patients undergoing TACE. METHODS/DESIGN: This study follows a registered protocol for a systematic review and meta-analysis. We will include randomized and non-randomized trials, prospective or retrospective cohort studies, and predictive model development articles that report risk factors for post-embolization syndrome (PES) after transarterial chemoembolization (TACE) in patients with liver cancer. The primary outcome is the risk factors for post-embolization syndrome. A comprehensive literature search will be conducted from database inception across PubMed, MEDLINE, EMBASE, Web of Science, Scopus, CINAHL Plus, OpenGrey, the Cochrane Library, Google Scholar, and the China National Knowledge Infrastructure (CNKI). Two researchers will independently screen titles, abstracts, and full texts. Risk of bias will be assessed using validated tools. Where studies have similar sample characteristics, assessment methods, research design type and corresponding outcomes, we will pool the results and apply various types of meta-analyses such as mean difference, standard mean difference, or Cox regression for continuous outcomes and risk ratio measurement or logistic regression for categorical outcomes depicted in odds ratios and 95% confidence intervals (CIs). Meta-regression will be used to analyze heterogeneity if necessary. DISCUSSION: This systematic review and meta-analysis will integrate evidence from both randomized and non-randomized studies, providing an updated and comprehensive synthesis of risk factors for PES after TACE in HCC patients. This study will also explore some factors that may explain the possible differences among different studies. The research results will be published in a peer-reviewed journal. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD420251218746.