Jayabalan Dujinthan, Dhakal Sugam, Raguragavan Aarohanan, Saxena Akshat, Jeffrey Gary P, Calzadilla-Bertot Luis, Adams Leon A, Wallace Michael C
Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Medical School, The University of Western Australia, Nedlands, Western Australia, Australia.
Int J Hepatol. 2025 Apr 7;2025:1083642. doi: 10.1155/ijh/1083642. eCollection 2025.
Poor outcomes in advanced hepatocellular carcinoma (HCC) coupled with potential significant treatment side effects underpin a strong rationale to assess health-related quality of life (HRQOL) in those treated with systemic therapies. This study is aimed at quantifying the effect of systemic therapies on HRQOL outcomes in HCC patients when compared to baseline or placebo, other systemic therapies, and transarterial radioembolisation (TARE). In May 2024, two independent reviewers searched PubMed, EMBASE, and Google Scholar for studies comparing postsystemic therapy HRQOL scores in adult patients with HCC to baseline or placebo, other systemic therapies, or to TARE. Narrative synthesis was used to synthesise results. Risk of bias was assessed using RoB 2 and ROBINS-I. This review was structured according to PRISMA guidelines and was prospectively registered in the PROSPERO register (CRD42024521699). Twenty-nine studies with 10,472 patients using eight HRQOL instruments were included. Compared to baseline, patients on atezolizumab/bevacizumab and sorafenib both experienced significant declines in HRQOL, and lenvatinib nonsignificantly decreased HRQOL. HRQOL remained unchanged in patients on pembrolizumab or nivolumab. Atezolizumab/bevacizumab and lenvatinib both significantly delayed HRQOL deterioration compared to sorafenib. Compared to TARE, atezolizumab/bevacizumab delayed time-to-deterioration in HRQOL, whereas sorafenib had significantly worse HRQOL. Despite worsening HRQOL outcomes compared to baseline, the first-line agents atezolizumab/bevacizumab and lenvatinib had superior HRQOL outcomes in comparison to sorafenib. Sorafenib significantly worsened HRQOL compared to TARE. As the majority of included studies included sorafenib, which has been largely superseded by newer therapies, further trials evaluating HRQOL with these newer therapies are required.
晚期肝细胞癌（HCC）预后不佳，且全身治疗可能产生严重的副作用，这为评估接受全身治疗患者的健康相关生活质量（HRQOL）提供了有力依据。本研究旨在量化全身治疗与基线或安慰剂、其他全身治疗以及经动脉放射栓塞术（TARE）相比，对HCC患者HRQOL结果的影响。2024年5月，两名独立评审员在PubMed、EMBASE和谷歌学术上检索了将成年HCC患者全身治疗后的HRQOL评分与基线或安慰剂、其他全身治疗或TARE进行比较的研究。采用叙述性综合法进行结果综合。使用RoB 2和ROBINS - I评估偏倚风险。本综述按照PRISMA指南进行构建，并在PROSPERO登记册（CRD42024521699）中进行了前瞻性登记。纳入了29项研究，共10472例患者，使用了8种HRQOL工具。与基线相比，接受阿替利珠单抗/贝伐单抗和索拉非尼治疗的患者HRQOL均显著下降，而乐伐替尼使HRQOL有非显著下降。接受帕博利珠单抗或纳武利尤单抗治疗的患者HRQOL保持不变。与索拉非尼相比，阿替利珠单抗/贝伐单抗和乐伐替尼均显著延迟了HRQOL恶化。与TARE相比，阿替利珠单抗/贝伐单抗延迟了HRQOL恶化时间，而索拉非尼的HRQOL显著更差。尽管与基线相比HRQOL结果恶化，但一线药物阿替利珠单抗/贝伐单抗和乐伐替尼与索拉非尼相比，HRQOL结果更优。与TARE相比，索拉非尼显著恶化了HRQOL。由于大多数纳入研究都包括索拉非尼，而索拉非尼在很大程度上已被更新的疗法所取代，因此需要进一步开展评估这些更新疗法HRQOL的试验。
