Song Young-Gi, Yeom Kyeong-Min, Jung Eun Ae, Kim Sang Gyune, Kim Young Seok, Yoo Jeong-Ju
Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyaung University College of Medicine, Bucheon, Republic of Korea.
Department of Medical Library, Soonchunhyang University Bucheon Hospital, Soonchunhyaung University College of Medicine, Bucheon, Republic of Korea.
Liver Cancer. 2024 May 22;13(6):590-600. doi: 10.1159/000539423. eCollection 2024 Dec.
The combination of atezolizumab/bevacizumab has emerged as an effective first-line treatment for advanced hepatocellular carcinoma (HCC). However, this therapy is potentially associated with bleeding complications, warranting a comprehensive analysis of their incidence and severity. This meta-analysis aims to synthesize available evidence from clinical trials and observational studies to quantify the prevalence of bleeding following atezolizumab/bevacizumab administration.
This meta-analysis focused on HCC treatment using atezolizumab/bevacizumab, particularly examining bleeding complications. It determined the prevalence of bleeding post-administration and compared the risk ratio with tyrosine kinase inhibitors (sorafenib or lenvatinib). Risk factors for bleeding complications were also evaluated.
From 28 studies involving 3,895 patients, the pooled prevalence of bleeding side effects was 8.42% (95% CI: 5.72-11.54). Grade III or IV bleeding occurred in 4.42% (95% CI: 2.64-6.10) of patients, with grade V bleeding observed in 2.06% (95% CI: 0.56-4.22). Gastrointestinal bleeding, predominantly variceal, was the most common, with a prevalence of 5.48% (95% CI: 3.98-7.17). Subgroup analysis indicated variability in bleeding rates based on study design and geographical location. Atezolizumab/bevacizumab treatment exhibited a 2.11 times higher prevalence of bleeding compared to tyrosine kinase inhibitors (95% CI: 1.21-3.66). Meta-regression identified high body mass index (BMI) and higher proportion of albumin-bilirubin (ALBI) grade 3 as significant risk factors for bleeding complications.
Atezolizumab/bevacizumab therapy for advanced HCC carries a heightened risk of gastrointestinal bleeding, exceeding that of tyrosine kinase inhibitors. High BMI and higher ALBI grade are key predictors of bleeding complications, emphasizing the need for cautious patient selection and monitoring.
阿替利珠单抗/贝伐珠单抗联合疗法已成为晚期肝细胞癌（HCC）有效的一线治疗方案。然而，该疗法可能与出血并发症相关，因此有必要对其发生率和严重程度进行全面分析。本荟萃分析旨在综合临床试验和观察性研究中的现有证据，以量化阿替利珠单抗/贝伐珠单抗给药后出血的发生率。
本荟萃分析聚焦于使用阿替利珠单抗/贝伐珠单抗治疗HCC，尤其关注出血并发症。它确定了给药后出血的发生率，并将风险比与酪氨酸激酶抑制剂（索拉非尼或仑伐替尼）进行比较。还评估了出血并发症的危险因素。
在涉及3895例患者的28项研究中，出血副作用的合并发生率为8.42%（95%置信区间：5.72 - 11.54）。4.42%（95%置信区间：2.64 - 6.10）的患者发生III级或IV级出血，2.06%（95%置信区间：0.56 - 4.22）的患者发生V级出血。胃肠道出血，主要是静脉曲张出血，最为常见，发生率为5.48%（95%置信区间：3.98 - 7.17）。亚组分析表明，根据研究设计和地理位置，出血率存在差异。与酪氨酸激酶抑制剂相比，阿替利珠单抗/贝伐珠单抗治疗的出血发生率高2.11倍（95%置信区间：1.21 - 3.66）。荟萃回归确定高体重指数（BMI）和较高比例的白蛋白-胆红素（ALBI）3级是出血并发症的重要危险因素。
阿替利珠单抗/贝伐珠单抗治疗晚期HCC会增加胃肠道出血风险，高于酪氨酸激酶抑制剂。高BMI和较高的ALBI分级是出血并发症的关键预测因素，强调了谨慎选择患者和进行监测的必要性。
