Yang Zhenyu, Tong Yao, Yang Lin, He Xianli, Bao Guoqiang, Du Xilin
Department of General Surgery, Tangdu Hospital, Air Force Military Medical University, Xi'an, China.
Department of Anesthesiology, Tangdu Hospital, Air Force Military Medical University, Xi'an, China.
Transl Gastroenterol Hepatol. 2022 Oct 25;7:38. doi: 10.21037/tgh-20-318. eCollection 2022.
Recently, increasing literature has been reported on optimal therapies in patients with advanced hepatocellular carcinoma (HCC) and many therapeutic modalities have been proposed to improve the survival rate. However, the results are not consistent due to different research protocols, small sample sizes and different study endpoints and there is no standard treatment protocol has been defined. Therefore, it is very important to explore the optimal bonding mode and to evaluate the efficacy and safety of the optimal sequential therapy for those patients.
We searched available databases through January 2020 for relevant studies. The main outcome measure was 1-year overall survival (OS) and overall response rate (ORR); the secondary outcome measure was a composite of toxic effects retrieved grade 3 or 4 adverse events (AEs) from all included studies. Statistical analyses were conducted using STATA version 15 and GeMTC package in the R statistical software.
After a detailed review, 8 randomized controlled trials (RCTs) and 20 retrospective studies involving 3,675 advanced HCC patients were included for network meta-analysis. Indirect comparisons showed that hepatic arterial infusion chemotherapy (HAIC) plus radiofrequency ablation (RFA) was highest probability of obtaining the best OS rate of 1 year [surface under the cumulative ranking (SUCRA), 0.95] and ORR (SUCRA, 0.86) when compared with other potential optimal therapies and which had ranked the first in all treatment regimens, followed by HAIC (SUCRA, 0.75). Direct and indirect comparison of 1-year OS and ORR with all treatment regimens each other showed that for all treatment regimens, patients showed significant clinical benefit when compared with transcatheter arterial chemoembolization (TACE) or sorafenib alone. However, the incidence of treatment-related AEs of grade 3 or 4 occurred in patients who have received targeted drug sorafenib therapy (SUCRA, 0.51) compared with other interesting regimens.
HAIC may be a valuable therapeutic strategy for advanced HCC patients to prevent recurrence and metastasis after RFA, as well as in improving patient prognosis and quality of life. Meanwhile, HAIC combined with RFA is a safe and effective treatment in patients with advanced HCC, and this combination therapy can significantly prolong 1-year survival rate when compared with other optimal sequential therapies.
This study is registered with PROSPERO, number CRD42020176149.
近年来，关于晚期肝细胞癌（HCC）患者最佳治疗方案的文献报道日益增多，人们提出了多种治疗方式以提高生存率。然而，由于研究方案不同、样本量小以及研究终点各异，结果并不一致，尚未确定标准治疗方案。因此，探索最佳联合模式并评估最佳序贯治疗对这些患者的疗效和安全性非常重要。
我们检索了截至2020年1月的可用数据库中的相关研究。主要观察指标为1年总生存率（OS）和总缓解率（ORR）；次要观察指标为从所有纳入研究中检索出的3级或4级不良事件（AE）的毒性效应综合指标。使用STATA 15版软件和R统计软件中的GeMTC包进行统计分析。
经过详细审查，纳入8项随机对照试验（RCT）和20项回顾性研究共3675例晚期HCC患者进行网状Meta分析。间接比较显示，与其他潜在的最佳治疗方案相比，肝动脉灌注化疗（HAIC）联合射频消融（RFA）获得1年最佳OS率（累积排序曲线下面积[SUCRA]，0.95）和ORR（SUCRA，0.86）的概率最高，在所有治疗方案中排名第一，其次是HAIC（SUCRA，0.75）。所有治疗方案之间1年OS和ORR的直接和间接比较显示，与单纯经动脉化疗栓塞术（TACE）或索拉非尼相比，所有治疗方案的患者均显示出显著的临床获益。然而，与其他相关方案相比，接受靶向药物索拉非尼治疗的患者发生3级或4级治疗相关AE的发生率（SUCRA，0.51）。
HAIC可能是晚期HCC患者RFA后预防复发和转移以及改善患者预后和生活质量的一种有价值的治疗策略。同时，HAIC联合RFA对晚期HCC患者是一种安全有效的治疗方法，与其他最佳序贯治疗相比，这种联合治疗可显著延长1年生存率。
本研究已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42020176149。
