Department of Minimally Invasive Interventional Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, Guangdong Province, China.
Department of Minimally Invasive Interventional Therapy, State Key Laboratory of Oncology in South China, Guangzhou 510060, Guangdong Province, China.
World J Gastroenterol. 2024 Jan 28;30(4):318-331. doi: 10.3748/wjg.v30.i4.318.
Hepatic arterial infusion chemotherapy (HAIC) has been proven to be an ideal choice for treating unresectable hepatocellular carcinoma (uHCC). HAIC-based treatment showed great potential for treating uHCC. However, large-scale studies on HAIC-based treatments and meta-analyses of first-line treatments for uHCC are lacking.
To investigate better first-line treatment options for uHCC and to assess the safety and efficacy of HAIC combined with angiogenesis inhibitors, programmed cell death of protein 1 (PD-1) and its ligand (PD-L1) blockers (triple therapy) under real-world conditions.
Several electronic databases were searched to identify eligible randomized controlled trials for this meta-analysis. Study-level pooled analyses of hazard ratios (HRs) and odds ratios (ORs) were performed. This was a retrospective single-center study involving 442 patients with uHCC who received triple therapy or angiogenesis inhibitors plus PD-1/PD-L1 blockades (AIPB) at Sun Yat-sen University Cancer Center from January 2018 to April 2023. Propensity score matching (PSM) was performed to balance the bias between the groups. The Kaplan-Meier method and cox regression were used to analyse the survival data, and the log-rank test was used to compare the suvival time between the groups.
A total of 13 randomized controlled trials were included. HAIC alone and in combination with sorafenib were found to be effective treatments ( values for ORs: HAIC, 0.95; for HRs: HAIC + sorafenib, 0.04). After PSM, 176 HCC patients were included in the analysis. The triple therapy group ( = 88) had a longer median overall survival than the AIPB group ( = 88) (31.6 months 14.6 months, < 0.001) and a greater incidence of adverse events (94.3% 75.4%, < 0.001).
This meta-analysis suggests that HAIC-based treatments are likely to be the best choice for uHCC. Our findings confirm that triple therapy is more effective for uHCC patients than AIPB.
肝动脉灌注化疗（HAIC）已被证明是治疗不可切除肝细胞癌（uHCC）的理想选择。基于 HAIC 的治疗方法在治疗 uHCC 方面显示出巨大的潜力。然而，目前缺乏基于 HAIC 的治疗方法的大规模研究和 uHCC 一线治疗的荟萃分析。
探讨更好的 uHCC 一线治疗选择，并评估在真实世界环境下，HAIC 联合血管生成抑制剂、程序性细胞死亡蛋白 1（PD-1）及其配体（PD-L1）阻滞剂（三联疗法）的安全性和疗效。
本荟萃分析检索了多个电子数据库，以确定合格的随机对照试验。对危险比（HRs）和优势比（ORs）进行了研究水平的汇总分析。这是一项回顾性单中心研究，纳入了 2018 年 1 月至 2023 年 4 月期间在中山大学肿瘤防治中心接受三联疗法或血管生成抑制剂联合 PD-1/PD-L1 阻滞剂（AIPB）治疗的 442 例 uHCC 患者。采用倾向评分匹配（PSM）平衡组间偏倚。Kaplan-Meier 法和 Cox 回归用于分析生存数据，对数秩检验用于比较组间生存时间。
共纳入 13 项随机对照试验。单独使用 HAIC 和联合索拉非尼均为有效治疗方法（OR 值：HAIC，0.95；HR 值：HAIC+索拉非尼，0.04）。PSM 后，有 176 例 HCC 患者纳入分析。三联疗法组（n=88）的中位总生存期长于 AIPB 组（n=88）（31.6 个月 14.6 个月，<0.001），且不良反应发生率更高（94.3% 75.4%，<0.001）。
本荟萃分析表明，基于 HAIC 的治疗方法可能是 uHCC 的最佳选择。我们的研究结果证实，三联疗法在治疗 uHCC 患者方面比 AIPB 更有效。
