经动脉化疗栓塞术联合免疫靶向治疗不可切除肝细胞癌的系统评价和荟萃分析。
Immune-targeted therapy with transarterial chemo(embolization) for unresectable HCC: a systematic review and meta-analysis.
机构信息
Department of Radiation Oncology, Jiangxi Clinical Research Center for Cancer, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China.
Department of Hepatopancreatobiliary Surgery, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, Fujian, China.
出版信息
Front Immunol. 2024 Aug 2;15:1421520. doi: 10.3389/fimmu.2024.1421520. eCollection 2024.
BACKGROUND
Transarterial chemo(embolization) is preferred for treating unresectable hepatocellular carcinoma (uHCC); however, because of emerging immune-targeted therapies, its efficacy is at stake. This systematic review pioneers to evaluate the clinical efficacy and safety of transarterial chemo(embolization) combined with immune-targeted therapy for uHCC patients.
METHODS
PubMed, Embase, and Cochrane Library were searched for studies comparing immune-targeted therapy with or without transarterial chemo(embolization) until 31 May 2024. The complete response (CR) rate, objective response rate (ORR), and disease control rate (DCR) were considered to be the primary outcomes calculated for the clinical outcomes of transarterial chemo(embolization) combined with immune-targeted therapy, along with progression-free survival (PFS) and overall survival (OS). The incidence of treatment-related severe adverse events was set as the major measure for the safety outcome.
RESULTS
Sixteen studies, encompassing 1,789 patients receiving transarterial chemo(embolization) plus immune-targeted therapy and 1,215 patients receiving immune-targeted therapy alone, were considered eligible. The combination of transarterial chemo(embolization) and immune-targeted therapy demonstrated enhanced outcomes in CR (OR = 2.12, 95% CI = 1.35-3.31), ORR (OR = 2.78, 95% CI = 2.15-3.61), DCR (OR = 2.46, 95% CI = 1.72-3.52), PFS (HR = 0.59, 95% CI = 0.50-0.70), and OS (HR = 0.51, 95% CI = 0.44-0.59), albeit accompanied by a surge in ALT (OR = 2.17, 95% CI = 1.28-3.68) and AST (OR = 2.28, 95% CI = 1.42-3.65). The advantages of additional transarterial chemo(embolization) to immune-targeted therapy were also verified in subgroups of first-line treatment, intervention techniques, with or without extrahepatic metastasis, Child-Pugh grade A or B, and with or without tumor thrombus.
CONCLUSION
The combination of transarterial chemo(embolization) and immune-targeted therapy seems to bolster local control and long-term efficacy in uHCC, albeit at the expense of hepatic complications.
SYSTEMATIC REVIEW REGISTRATION
http://www.crd.york.ac.uk/PROSPERO/, identifier 474669.
背景
经动脉化疗栓塞术（TACE）是治疗不可切除肝细胞癌（uHCC）的首选方法；然而，由于新兴的免疫靶向治疗，其疗效受到了挑战。本系统评价旨在评估 TACE 联合免疫靶向治疗对 uHCC 患者的临床疗效和安全性。
方法
检索 PubMed、Embase 和 Cochrane Library 数据库，截至 2024 年 5 月 31 日，比较免疫靶向治疗联合与不联合 TACE 治疗 uHCC 的研究。完全缓解（CR）率、客观缓解率（ORR）和疾病控制率（DCR）被认为是 TACE 联合免疫靶向治疗的主要临床结局指标，同时还评估了无进展生存期（PFS）和总生存期（OS）。治疗相关严重不良事件的发生率作为安全性结局的主要指标。
结果
纳入了 16 项研究，共纳入 1789 例接受 TACE 联合免疫靶向治疗的患者和 1215 例接受免疫靶向治疗的患者。TACE 联合免疫靶向治疗可提高 CR（OR=2.12，95%CI=1.35-3.31）、ORR（OR=2.78，95%CI=2.15-3.61）、DCR（OR=2.46，95%CI=1.72-3.52）、PFS（HR=0.59，95%CI=0.50-0.70）和 OS（HR=0.51，95%CI=0.44-0.59），但 ALT（OR=2.17，95%CI=1.28-3.68）和 AST（OR=2.28，95%CI=1.42-3.65）升高的风险也增加。在一线治疗、介入技术、有无肝外转移、Child-Pugh 分级 A 或 B、有无肿瘤血栓等亚组中，也验证了 TACE 联合免疫靶向治疗的优势。
结论
TACE 联合免疫靶向治疗似乎可以提高 uHCC 的局部控制和长期疗效，但代价是肝脏并发症。
系统评价注册
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