Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro, Madrid, Spain.
Liver Oncology Unit, Liver Unit, Hospital Clínic, Barcelona, Spain.
Hepatology. 2023 Apr 1;77(4):1139-1149. doi: 10.1097/HEP.0000000000000030. Epub 2023 Jan 13.
Immunotherapy-based regimes have changed the management of HCC. However, evidence of efficacy in patients with impaired liver function is unknown. This systematic review and meta-analysis assesses survival of HCC patients and liver dysfunction treated with immunotherapy-based regimens.
Systematic review and meta-analysis of original articles or abstracts reporting survival of HCC patients treated with immunotherapy according to liver function between 2017 and 2022. Overal survival (OS) according to restricted mean survival time (RMST) and median OS, and hazard ratio (HR) of Child-Pugh B or B/C versus Child-Pugh A were assessed while considering the line of treatment.
Of the 2218 articles considered, 15 articles recruiting 2311 patients were included. Of these, 639 (27.7%) were Child-Pugh B and 34 (1.5%) C. RMST was 8.36 (95% CI, 6.15-10.57; I2 =93%) months, estimated from 8 studies. The HR was reported in 8 studies for survival between Child-Pugh B versus Child-Pugh A and metanalysis disclosed a 1.65 HR (95% CI,1.45-1.84; I2 =0% heterogeneity; p = 0.45). Treatment line data were available for 47% of the patients and 3 studies included patients treated with atezolizumab-bevacizumab in the first line.
The high heterogeneity across studies reflects the incapacity of the current evidence to support the indication of immunotherapy in HCC patients with relevant liver dysfunction. It is mandatory to report complementary information to Child-Pugh classification such as prior liver decompensation, use of concomitant medication to control ascites, or signs of clinically significant portal hypertension to allow better patient stratification in future studies.
基于免疫疗法的治疗方案改变了 HCC 的治疗管理。然而，对于肝功能受损的患者的疗效证据尚不清楚。本系统评价和荟萃分析评估了接受基于免疫疗法的治疗方案治疗的 HCC 患者的生存情况和肝功能障碍。
系统检索 2017 年至 2022 年期间发表的评估根据肝功能接受免疫治疗的 HCC 患者生存情况的原始文章或摘要的荟萃分析。根据受限平均生存时间（RMST）和中位 OS 评估总体生存率（OS），并考虑治疗线评估 Child-Pugh B 或 B/C 与 Child-Pugh A 的风险比（HR）。
在考虑的 2218 篇文章中，有 15 篇文章纳入了 2311 名患者。其中，639 名（27.7%）为 Child-Pugh B，34 名（1.5%）为 C。8 项研究估计的 RMST 为 8.36 个月（95%CI，6.15-10.57；I2=93%）。8 项研究报告了生存情况的 HR，Child-Pugh B 与 Child-Pugh A 之间的 HR 分析显示为 1.65（95%CI，1.45-1.84；I2=0%异质性；p=0.45）。47%的患者可获得治疗线数据，3 项研究纳入了接受阿替利珠单抗-贝伐珠单抗一线治疗的患者。
研究之间的高度异质性反映了目前的证据不足以支持在具有相关肝功能障碍的 HCC 患者中使用免疫疗法的适应证。必须报告补充信息，如既往肝失代偿、使用伴随药物控制腹水或有临床显著门静脉高压的迹象，以便在未来的研究中更好地对患者进行分层。
