晚期肝细胞癌的非手术治疗：安大略癌症护理组织的系统评价
Non-surgical management of advanced hepatocellular carcinoma: A systematic review by Cancer Care Ontario.
作者信息
Meyers Brandon M, Knox Jennifer J, Cosby Roxanne, Beecroft J R, Chan Kelvin Kw, Coburn Natalie, Feld Jordan J, Jonker Derek, Mahmud Aamer, Ringash Jolie
机构信息
Juravinski Cancer Centre, Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
出版信息
Can Liver J. 2021 Aug 9;4(3):257-274. doi: 10.3138/canlivj-2020-0039. eCollection 2021 Summer.
BACKGROUND
Hepatocellular carcinoma (HCC) is a global health problem, accounting for 4.7% of all new cancer cases and 8.2% of all cancer deaths worldwide in 2018. Resection and transplantation are the only modalities that offer a cure for HCC; however, most patients are diagnosed at an advanced stage, precluding these curative treatments. A number of local (ie, ablative therapies) and/or local-regional therapies (ie, chemo-embolization) are used and followed by systemic therapy for advanced or progressive disease. Other treatments are available, but their efficacy compared with these standards is not well known.
METHODS
Literature searches (1/2000 to 1/2020 or 1/2005 to 1/2020, depending on the specific systematic review question) were conducted, including MEDLINE, Embase and the Cochrane Database of Systematic Reviews.
RESULTS
Over 30,000 articles were identified. In total, 49 studies were included in the systematic review.
CONCLUSIONS
There is no evidence to support the addition of sorafenib to any local or regional therapy. First-line systemic therapy options for unresectable or metastatic HCC include sorafenib, lenvatinib, and atezolizumab + bevacizumab. Regorafenib or cabozantinib provide survival benefits when given as second-line treatment.
背景
肝细胞癌（HCC）是一个全球性的健康问题，在2018年占全球所有新发癌症病例的4.7%和所有癌症死亡人数的8.2%。肝切除术和肝移植是仅有的能治愈HCC的治疗方式；然而，大多数患者在晚期才被诊断出来，无法接受这些治愈性治疗。对于晚期或进展性疾病，会采用多种局部（即消融治疗）和/或局部区域治疗（即化疗栓塞），随后进行全身治疗。还有其他治疗方法，但与这些标准治疗方法相比，其疗效尚不清楚。
方法
进行文献检索（根据具体的系统评价问题，检索时间为2000年1月至2020年1月或2005年1月至2020年1月），包括MEDLINE数据库、Embase数据库和Cochrane系统评价数据库。
结果
共识别出30000多篇文章。系统评价共纳入49项研究。
结论
没有证据支持在任何局部或区域治疗中加用索拉非尼。不可切除或转移性HCC的一线全身治疗选择包括索拉非尼、仑伐替尼以及阿替利珠单抗+贝伐单抗。瑞戈非尼或卡博替尼作为二线治疗可带来生存获益。
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