全身治疗联合肝动脉灌注化疗栓塞术与单纯全身治疗用于肝细胞癌的疗效比较：一项系统评价与荟萃分析

Systemic therapy plus HAIC versus systemic therapy for hepatocellular carcinoma: a systematic review and meta-analysis.

作者信息

Lu Donghai, Li Han, Sun Pengfei, Tian Jincheng, Jiao Kefan, Cao Qihang, Wang Yuxuan, Jia Jisen, He Qiao, Peng Shengxuan, Zhang Daolin, Dong Zhaoru, Wang Dongxu, Li Tao

机构信息

Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China.

Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.

出版信息

Int J Surg. 2025 May 1;111(5):3494-3507. doi: 10.1097/JS9.0000000000002326.

BACKGROUND

Hepatic arterial infusion chemotherapy (HAIC) exhibits synergistic anticancer effects with systemic therapy in treating hepatocellular carcinoma (HCC). The approach combining systemic therapy and HAIC is likely to establish a new survival benchmark for advanced HCC. However, related evidence is still lacking.

METHOD

PubMed, Embase, Cochrane Library, and Web of Science were searched from January 1990 to July 2024. The extracted data were pooled using fixed- or random-effects models and expressed as hazard ratios (HRs) or risk ratios (RRs) with corresponding 95% confidence intervals (CIs). Meta-regression, subgroup analysis, prognostic factor analysis, correlation analysis, as well as trial sequential analysis were further conducted.

RESULT

Seventeen trials involving 3070 participants were included. Patients receiving HAIC combined systemic therapy displayed superior overall survival (OS) (HR, 0.52; 95% CI, 0.48-0.58), progression-free survival (PFS) (HR, 0.54; 95% CI, 0.46-0.63), objective response rate (ORR) (RR, 2.20; 95% CI, 1.77-2.72) and disease control rate (RR, 1.21; 95% CI, 1.14-1.29) over systemic therapy. Combining HAIC resulted in higher incidences of grade ≥3 manageable adverse events. Subgroup analyses showed that HAIC could bring significant survival improvement for almost all specific populations; however, patients without portal vein tumor thrombosis might not benefit from it (HR, 0.74; 95% CI, 0.53-1.03). Prognostic factor analyses found extra HAIC was a protective factor for both OS (HR, 0.42; 95% CI, 0.34-0.51) and PFS (HR, 0.44; 95% CI, 0.36-0.53). Correlation analyses demonstrated a robust association between ORR and OS when applying systemic therapy with HAIC ( P -value = 0.031). In addition, trial sequential analyses visually showed the present data were compelling to draw reliable conclusions.

CONCLUSION

With manageable toxicity, integrating HAIC with systemic therapy could bring favorable survival benefits for HCC patients. Further evidence is necessary to standardize the integration of HAIC with first-line systemic therapy.

背景

肝动脉灌注化疗（HAIC）在治疗肝细胞癌（HCC）时与全身治疗具有协同抗癌作用。全身治疗与HAIC相结合的方法可能会为晚期HCC建立新的生存基准。然而，相关证据仍然不足。

方法

检索了1990年1月至2024年7月期间的PubMed、Embase、Cochrane图书馆和Web of Science。使用固定效应或随机效应模型汇总提取的数据，并表示为风险比（HRs）或风险率（RRs）以及相应的95%置信区间（CIs）。进一步进行了Meta回归、亚组分析、预后因素分析、相关性分析以及试验序贯分析。

结果

纳入了17项试验，涉及3070名参与者。接受HAIC联合全身治疗的患者在总生存期（OS）（HR，0.52；95%CI，0.48 - 0.58）、无进展生存期（PFS）（HR，0.54；95%CI，0.46 - 0.63）、客观缓解率（ORR）（RR，2.20；95%CI，1.77 - 2.72）和疾病控制率（RR，1.21；95%CI，1.14 - 1.29）方面均优于全身治疗。联合HAIC导致≥3级可管理不良事件的发生率更高。亚组分析表明，HAIC几乎可以为所有特定人群带来显著的生存改善；然而，没有门静脉肿瘤血栓形成的患者可能无法从中获益（HR，0.74；95%CI，0.53 - 1.03）。预后因素分析发现额外的HAIC是OS（HR，0.42；95%CI，0.34 - 0.51）和PFS（HR，0.44；95%CI，0.36 - 0.53）的保护因素。相关性分析表明，在应用全身治疗联合HAIC时，ORR与OS之间存在显著关联（P值 = 0.031）。此外，试验序贯分析直观地显示当前数据足以得出可靠结论。