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.
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。