Cui Ran, Yu Xinlin, Jiang Yan, Li Xingming
Department of Oncology, The First People's Hospital of Neijiang, Neijiang, Sichuan 641000, P.R. China.
Department of Oncology, Affiliated Hospital of Chengdu University, Chengdu, Sichuan 610000, P.R. China.
Oncol Lett. 2025 Jul 28;30(4):460. doi: 10.3892/ol.2025.15206. eCollection 2025 Oct.
Limited treatment options are available for patients with advanced stages of hepatocellular carcinoma (HCC), which is a major global health challenge. The present systematic review and meta-analysis examined the therapeutic potential of the combination of immune checkpoint inhibitors (ICIs) and radiotherapy (RT) for advanced (a)HCC or unresectable HCC. The PubMed, Embase, Cochrane Library and Web of Science databases were searched to identify studies examining the therapeutic efficacy of the ICI-RT combination for aHCC published until August 31, 2024. The following clinical outcomes were analyzed: Objective response rate (ORR), median progression-free survival (mPFS) and median overall survival (mOS). Additionally, targeted subgroup analyses were performed based on tumor thrombus presence and the use of transarterial chemoembolization (TACE) and stereotactic body RT. The present single-arm meta-analysis, encompassing 16 studies involving 633 patients with aHCC or unresectable HCC, revealed that the ICI-RT combination exhibits potent therapeutic efficacy. The pooled ORR of patients in the ICI-RT combination group was 54.4% [95% confidence interval (CI), 46.8-62.0%]. The mPFS and mOS of patients treated with the ICI-RT combination were 10.1 (95% CI, 7.2-12.9) and 18.3 months (95% CI, 14.6-21.9), respectively. The ORR of patients in the TACE combination subgroup was 53.8% (95% CI, 44.6-62.9%). Meanwhile, the ORR and mOS of patients with Barcelona Clinic Liver Cancer stage C tumors were 55.6% (95% CI, 44.3-66.9%) and 21.2 months (95% CI, 13.5-29.0), respectively. These findings suggest that ICI and RT exert synergistic effects. The ICI-RT combination, a promising therapeutic regime for aHCC, is associated with potent efficacy and favorable ORR and survival outcomes. Further studies are needed to optimize treatment strategies and identify patient subgroups who can benefit from this approach. The findings of the present study contribute to advances in aHCC treatment. The protocol for the present systematic review was registered at PROSPERO (registration no. CRD42024583148) and is available in full on the Health Technology Assessment website of the National Institutes of Health (http://www.hta.ac.uk/2283).
对于晚期肝细胞癌（HCC）患者而言，可用的治疗选择有限，这是一项重大的全球健康挑战。本系统评价和荟萃分析研究了免疫检查点抑制剂（ICI）与放疗（RT）联合应用于晚期（a）HCC或不可切除HCC的治疗潜力。检索了PubMed、Embase、Cochrane图书馆和Web of Science数据库，以识别截至2024年8月31日发表的关于ICI-RT联合治疗aHCC疗效的研究。分析了以下临床结局：客观缓解率（ORR）、中位无进展生存期（mPFS）和中位总生存期（mOS）。此外，还根据肿瘤血栓的存在情况以及经动脉化疗栓塞（TACE）和立体定向体部放疗的使用情况进行了针对性亚组分析。本单臂荟萃分析纳入了16项研究，涉及633例aHCC或不可切除HCC患者，结果显示ICI-RT联合治疗具有强大的治疗效果。ICI-RT联合治疗组患者的汇总ORR为54.4%[95%置信区间（CI），46.8-62.0%]。接受ICI-RT联合治疗的患者的mPFS和mOS分别为10.1（95%CI，7.2-12.9）和18.3个月（95%CI，14.6-21.9）。TACE联合亚组患者的ORR为53.8%（95%CI，44.6-62.9%）。同时，巴塞罗那临床肝癌C期肿瘤患者的ORR和mOS分别为55.6%（95%CI，44.3-66.9%）和21.2个月（95%CI，13.5-29.0）。这些发现表明ICI和RT具有协同作用。ICI-RT联合治疗是一种有前景的aHCC治疗方案，具有强大的疗效以及良好的ORR和生存结局。需要进一步研究以优化治疗策略，并确定能从这种方法中获益的患者亚组。本研究结果有助于推动aHCC治疗的进展。本系统评价的方案已在PROSPERO注册（注册号CRD42024583148），可在国立卫生研究院的卫生技术评估网站（http://www.hta.ac.uk/2283）上全文获取。
