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Abstract：
BACKGROUND: Hepatic arterial infusion chemotherapy (HAIC) has been proven to be an ideal choice for treating unresectable hepatocellular carcinoma (uHCC). HAIC-based treatment showed great potential for treating uHCC. However, large-scale studies on HAIC-based treatments and meta-analyses of first-line treatments for uHCC are lacking.
OBJECTIVE: To investigate better first-line treatment options for uHCC and to assess the safety and efficacy of HAIC combined with angiogenesis inhibitors, programmed cell death of protein 1 (PD-1) and its ligand (PD-L1) blockers (triple therapy) under real-world conditions.
METHODS: Several electronic databases were searched to identify eligible randomized controlled trials for this meta-analysis. Study-level pooled analyses of hazard ratios (HRs) and odds ratios (ORs) were performed. This was a retrospective single-center study involving 442 patients with uHCC who received triple therapy or angiogenesis inhibitors plus PD-1/PD-L1 blockades (AIPB) at Sun Yat-sen University Cancer Center from January 2018 to April 2023. Propensity score matching (PSM) was performed to balance the bias between the groups. The Kaplan-Meier method and cox regression were used to analyse the survival data, and the log-rank test was used to compare the suvival time between the groups.
RESULTS: A total of 13 randomized controlled trials were included. HAIC alone and in combination with sorafenib were found to be effective treatments (P values for ORs: HAIC, 0.95; for HRs: HAIC + sorafenib, 0.04). After PSM, 176 HCC patients were included in the analysis. The triple therapy group (n = 88) had a longer median overall survival than the AIPB group (n = 88) (31.6 months vs 14.6 months, P < 0.001) and a greater incidence of adverse events (94.3% vs 75.4%, P < 0.001).
CONCLUSIONS: This meta-analysis suggests that HAIC-based treatments are likely to be the best choice for uHCC. Our findings confirm that triple therapy is more effective for uHCC patients than AIPB.
OBJECTIVE: To investigate better first-line treatment options for uHCC and to assess the safety and efficacy of HAIC combined with angiogenesis inhibitors, programmed cell death of protein 1 (PD-1) and its ligand (PD-L1) blockers (triple therapy) under real-world conditions.
METHODS: Several electronic databases were searched to identify eligible randomized controlled trials for this meta-analysis. Study-level pooled analyses of hazard ratios (HRs) and odds ratios (ORs) were performed. This was a retrospective single-center study involving 442 patients with uHCC who received triple therapy or angiogenesis inhibitors plus PD-1/PD-L1 blockades (AIPB) at Sun Yat-sen University Cancer Center from January 2018 to April 2023. Propensity score matching (PSM) was performed to balance the bias between the groups. The Kaplan-Meier method and cox regression were used to analyse the survival data, and the log-rank test was used to compare the suvival time between the groups.
RESULTS: A total of 13 randomized controlled trials were included. HAIC alone and in combination with sorafenib were found to be effective treatments (P values for ORs: HAIC, 0.95; for HRs: HAIC + sorafenib, 0.04). After PSM, 176 HCC patients were included in the analysis. The triple therapy group (n = 88) had a longer median overall survival than the AIPB group (n = 88) (31.6 months vs 14.6 months, P < 0.001) and a greater incidence of adverse events (94.3% vs 75.4%, P < 0.001).
CONCLUSIONS: This meta-analysis suggests that HAIC-based treatments are likely to be the best choice for uHCC. Our findings confirm that triple therapy is more effective for uHCC patients than AIPB.
摘要：
背景：肝动脉灌注化疗（HAIC）已被证明是治疗不可切除的肝细胞癌（uHCC）的理想选择。基于HAIC的治疗显示出治疗uHCC的巨大潜力。然而,缺乏基于HAIC治疗的大规模研究和uHCC一线治疗的荟萃分析。
目的：为了研究更好的uHCC一线治疗方案，并评估HAIC联合血管生成抑制剂的安全性和有效性，在现实条件下，蛋白质1（PD-1）及其配体（PD-L1）阻断剂（三联疗法）的程序性细胞死亡。
方法：检索了几个电子数据库，以确定符合本荟萃分析的随机对照试验。对风险比（HRs）和比值比（ORs）进行研究水平的汇总分析。这是一项回顾性单中心研究，涉及442例uHCC患者，他们于2018年1月至2023年4月在中山大学肿瘤中心接受三联疗法或血管生成抑制剂加PD-1/PD-L1阻断（AIPB）治疗。进行倾向评分匹配（PSM）以平衡组间的偏倚。采用Kaplan-Meier法和cox回归分析生存数据,并采用对数秩检验比较各组间的存活时间。
结果：共纳入13项随机对照试验。发现单独使用HAIC和与索拉非尼联合使用是有效的治疗方法（ORs的P值：HAIC，0.95；对于HR：HAIC+索拉非尼，0.04).PSM之后,176例HCC患者被纳入分析。三联疗法组（n=88）的中位总生存期长于AIPB组（n=88）（31.6个月vs14.6个月，P<0.001）和更高的不良事件发生率（94.3％vs75.4％，P<0.001)。
结论：这项荟萃分析表明，基于HAIC的治疗可能是uHCC的最佳选择。我们的发现证实三联疗法对uHCC患者比AIPB更有效。
目的：为了研究更好的uHCC一线治疗方案，并评估HAIC联合血管生成抑制剂的安全性和有效性，在现实条件下，蛋白质1（PD-1）及其配体（PD-L1）阻断剂（三联疗法）的程序性细胞死亡。
方法：检索了几个电子数据库，以确定符合本荟萃分析的随机对照试验。对风险比（HRs）和比值比（ORs）进行研究水平的汇总分析。这是一项回顾性单中心研究，涉及442例uHCC患者，他们于2018年1月至2023年4月在中山大学肿瘤中心接受三联疗法或血管生成抑制剂加PD-1/PD-L1阻断（AIPB）治疗。进行倾向评分匹配（PSM）以平衡组间的偏倚。采用Kaplan-Meier法和cox回归分析生存数据,并采用对数秩检验比较各组间的存活时间。
结果：共纳入13项随机对照试验。发现单独使用HAIC和与索拉非尼联合使用是有效的治疗方法（ORs的P值：HAIC，0.95；对于HR：HAIC+索拉非尼，0.04).PSM之后,176例HCC患者被纳入分析。三联疗法组（n=88）的中位总生存期长于AIPB组（n=88）（31.6个月vs14.6个月，P<0.001）和更高的不良事件发生率（94.3％vs75.4％，P<0.001)。
结论：这项荟萃分析表明，基于HAIC的治疗可能是uHCC的最佳选择。我们的发现证实三联疗法对uHCC患者比AIPB更有效。
