经动脉化疗栓塞联合酪氨酸激酶抑制剂和程序性死亡受体-1抑制剂治疗不可切除肝细胞癌：一项系统评价和荟萃分析

Transarterial chemoembolization combined with tyrosine kinase inhibitors and programmed death receptor-1 inhibitors for unresectable hepatocellular carcinoma: a systematic review and meta-analysis.

作者信息

He Yonghong, Liu Yuexi, Xu Jie, He Yanan

机构信息

Hepatobiliary Surgery, The People's Hospital of Jiangyou, Jiangyou, China.

The Second College of Clinical Medicine, Dalian Medical University, Dalian, China.

出版信息

Transl Cancer Res. 2025 Aug 31;14(8):4976-4988. doi: 10.21037/tcr-2025-798. Epub 2025 Aug 28.

BACKGROUND

More than 60% of patients with hepatocellular carcinoma (HCC) are diagnosed at the intermediate-advanced stages, which are not amenable to surgical resection and ablation. The optimal treatment plan for patients with unresectable HCC remains controversial. This study aimed to evaluate the efficacy and safety of transarterial chemoembolization (TACE) combined with tyrosine kinase inhibitors (TKI) plus programmed death receptor-1 (PD-1) inhibitors (TACE + TKI + PD-1) versus TACE combined with TKI (TACE + TKI) among patients with unresectable HCC.

METHODS

A comprehensive search of the PubMed, EMBASE and the Cochrane Library databases was performed, and all studies related to TACE + TKI + PD-1 and TACE + TKI for treatment of HCC were included. We calculated risk ratio (RR) and mean difference for dichotomous and continuous outcomes. Data were analyzed using RevMan5.4 and Stata 17.0. We conducted a subgroup analysis based on specific types of TKI.

RESULTS

A total of 12 retrospective studies were included in the analysis, involving 1,078 patients in the TACE + TKI + PD-1 group and 1,332 in the TACE + TKI group. Compared with the TACE + TKI group, the TACE + TKI + PD-1 group showed prolonged overall survival [RR =7.39, 95% confidence interval (CI): 5.69-9.08, P<0.001, I=90%], progression-free survival (RR =3.89, 95% CI: 3.21-4.57, P<0.001, I=81%)and higher objective response rate (RR =1.38, 95% CI: 1.26-1.51, P<0.001, I=49%). Similarly, the 1-year survival rate improved (RR =5.92, 95% CI: 4.43-5.92, P<0.001, I=11%) in the TACE + TKI + PD-1 group. No significant difference was found in adverse events between the two groups.

CONCLUSIONS

TACE + TKI + PD-1 significantly improved survival outcomes and demonstrated superior efficacy and a manageable safety profile in the systemic treatment of patients with unresectable HCC.

背景

超过60%的肝细胞癌（HCC）患者在中晚期被诊断出来，这些阶段不适用于手术切除和消融。不可切除HCC患者的最佳治疗方案仍存在争议。本研究旨在评估经动脉化疗栓塞术（TACE）联合酪氨酸激酶抑制剂（TKI）加程序性死亡受体-1（PD-1）抑制剂（TACE + TKI + PD-1）与TACE联合TKI（TACE + TKI）在不可切除HCC患者中的疗效和安全性。

方法

对PubMed、EMBASE和Cochrane图书馆数据库进行全面检索，纳入所有与TACE + TKI + PD-1和TACE + TKI治疗HCC相关的研究。我们计算了二分法和连续结果的风险比（RR）和平均差。使用RevMan5.4和Stata 17.0进行数据分析。我们根据TKI的特定类型进行了亚组分析。

结果

分析共纳入12项回顾性研究，TACE + TKI + PD-1组1078例患者，TACE + TKI组1332例患者。与TACE + TKI组相比，TACE + TKI + PD-1组的总生存期延长[RR = 7.39，95%置信区间（CI）：5.69 - 9.08，P < 0.001，I = 90%]，无进展生存期（RR = 3.89，95% CI：3.21 - 4.57，P < 0.001，I = 81%），客观缓解率更高（RR = 1.38，95% CI：- 1.51，P < 0.001，I = 49%）。同样，TACE + TKI + PD-1组的1年生存率提高（RR = 5.92，95% CI：4.43 - 5.92，P < 0.001，I = 11%）。两组不良事件无显著差异。