Zeng Qingteng, Zhang Renjie, Zheng Xuan, Li Xiaobing, He Qinghua, Zhang Ruikun, Wu Shenfeng, Chen Boqian
The First Department of Surgery, Shenzhen Traditional Chinese Medicine Hospital, The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China.
The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China.
Oncol Res Treat. 2025 May 15:1-19. doi: 10.1159/000546337.
Standard treatments for intermediate-stage hepatocellular carcinoma (HCC), such as transarterial chemoembolization (TACE), offer limited efficacy, necessitating the exploration of additional therapeutic strategies. Tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) have shown potential to enhance HCC outcomes when combined with TACE. This meta-analysis aimed to evaluate safety and efficacy of TACE, TKIs, and ICIs (TACE + T + I) combination compared to TACE with TKIs alone (TACE + T) in patients with HCC.
A systematic search was performed in "PubMed," "Google Scholar," "Cochrane Library," "Web of Science," "Scopus," and "Embase" databases on November 1, 2024. Studies involving patients with HCC comparing TACE + T + I versus TACE + T were included. Efficacy outcomes including objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), and adverse events were extracted. Meta-analysis was conducted using RevMan 5.4.
Seventeen studies were included for analysis. Pooled analysis showed a marked improvement in ORR (risk ratio [RR] = 1.57, 95% CI: 1.36-1.80, p < 0.00001) and DCR (RR = 1.13, 95% CI: 1.06-1.20, p = 0.0004) for TACE + T + I regimen over TACE + T. TACE + T + I group also showed a marked benefit in OS (hazard ratio [HR] = 0.37, 95% CI: 0.29-0.48, p < 0.0001) and PFS (HR = 0.44, 95% CI: 0.36-0.53, p < 0.0001). No differences in adverse events were detected between the two groups, indicating comparable tolerability.
The findings suggest that the addition of ICIs to TACE and TKI therapy offers substantial efficacy benefits without increasing toxicity for HCC patients. This combination therapy shows potential to improve DCR, ORR, PFS, and OS, underscoring the value of immunotherapy in enhancing outcomes in HCC. However, further randomized trials with standardized treatment protocols are needed to confirm these results and inform clinical guidelines.
对于中期肝细胞癌（HCC）的标准治疗，如经动脉化疗栓塞术（TACE），疗效有限，因此需要探索其他治疗策略。酪氨酸激酶抑制剂（TKIs）和免疫检查点抑制剂（ICIs）与TACE联合使用时，已显示出改善HCC治疗效果的潜力。本荟萃分析旨在评估TACE、TKIs和ICIs（TACE + T + I）联合治疗与单独使用TACE和TKIs（TACE + T）治疗HCC患者的安全性和疗效。
于2024年11月1日在“PubMed”、“谷歌学术”、“Cochrane图书馆”、“科学网”、“Scopus”和“Embase”数据库中进行了系统检索。纳入了比较TACE + T + I与TACE + T的HCC患者研究。提取了包括客观缓解率（ORR）、疾病控制率（DCR）、总生存期（OS）、无进展生存期（PFS）和不良事件在内的疗效结果。使用RevMan 5.4进行荟萃分析。
纳入17项研究进行分析。汇总分析显示，与TACE + T相比，TACE + T + I方案的ORR（风险比[RR] = 1.57，95%CI：1.36 - 1.80，p < 0.00001）和DCR（RR = 1.13，95%CI：1.06 - 1.20，p = 0.0004）有显著改善。TACE + T + I组在OS（风险比[HR] = 0.37，95%CI：0.29 - 0.48，p < 0.0001）和PFS（HR = 0.44，95%CI：0.36 - 0.53，p < 0.0001）方面也显示出显著益处。两组在不良事件方面未检测到差异，表明耐受性相当。
研究结果表明，在TACE和TKI治疗中添加ICIs可显著提高疗效，且不会增加HCC患者的毒性。这种联合治疗显示出改善DCR、ORR、PFS和OS的潜力，强调了免疫疗法在提高HCC治疗效果方面的价值。然而，需要进一步开展采用标准化治疗方案的随机试验来证实这些结果，并为临床指南提供依据。
