肝细胞癌(HCC)是一种与高发病率和死亡率相关的恶性肿瘤。转换治疗为无法切除的HCC(uHCC)患者提供了接受根治性治疗并实现长期生存的机会。尽管越来越多的证据表明转换治疗的疗效,这种疗法的最佳治疗方法仍不确定.Lenvatinib(LEN)在过去十年中与免疫检查点抑制剂(ICIs)或局部治疗(LRT)联合应用时显示出疗效和不良事件(AE)的可耐受率。因此,本荟萃分析旨在系统评估基于LEN的治疗方案在uHCC转换治疗中的安全性和有效性.关于成果的数据,包括转化率,客观反应率(ORR),uHCC患者的疾病控制率(DCR)和AE发生率,被收集。使用MEDLINE进行了系统的文献检索,Embase,WebofScience和Cochrane图书馆数据库,截止日期为2023年9月1日。总的来说,16项研究,总共包括1,650例uHCC,被纳入最终的荟萃分析。单独LEN的合并转化率,LEN+ICI、LEN+LRT和LEN+ICI+LRT计算为0.04(95%CI,0.00-0.07;I2=77%),0.23(95%CI,0.16-0.30;I2=66%),0.14(95%CI,0.10-0.18;I2=0%)和0.35(95%CI,0.23-0.47;I2=88%),分别。单独LEN的合并ORR,LEN+ICI、LEN+LRT和LEN+ICI+LRT分别为0.45(95%CI,0.23-0.67;I2=96%),0.49(95%CI,0.39-0.60;I2=78%),0.43(95%CI,0.24-0.62;I2=88%)和0.69(95%CI,0.56-0.82;I2=92%),分别。单独LEN的合并DCRs,观察到LEN+ICI、LEN+LRT和LEN+ICI+LRT为0.77(95%CI,0.73-0.81;I2=23%),0.82(95%CI,0.69-0.95;I2=90%),0.67(95%CI,0.39-0.94;I2=94%)和0.87(95%CI,0.82-0.93;I2=67%),分别。单独LEN的合并等级≥3AE,LEN+ICI、LEN+LRT和LEN+ICI+LRT分别为0.25(95%CI,0.14-0.36;I2=89%),0.43(95%CI,0.34-0.53;I2=23%),0.42(95%CI,0.19-0.66;I2=81%)和0.35(95%CI,0.17-0.54;I2=94%),分别。这些发现表明,基于LEN的组合策略可以为uHCC患者提供疗效和可接受的耐受性。特别是,LEN+ICI,有或没有轻轨,似乎代表了一种非常有效的转化方案,具有可接受的转化率和良好的安全性。
Hepatocellular carcinoma (HCC) is a malignancy associated with high morbidity and mortality rates. Conversion therapy provides patients with unresectable HCC (uHCC) the opportunity to undergo radical treatment and achieve long-term survival. Despite accumulating evidence regarding the efficacy of conversion therapy, the optimal treatment approach for such therapy remains uncertain. Lenvatinib (LEN) has shown efficacy and tolerable rates of adverse events (AEs) when applied in combination with immune checkpoint inhibitors (ICIs) or locoregional therapy (LRT) over the past decade. Therefore, the present meta-analysis was performed to systematically assess the safety and efficacy of LEN-based treatment regimens in conversion therapies for uHCC. Data on outcomes, including the conversion rate, objective response rate (ORR), disease control rate (DCR) and AE incidence in patients with uHCC, were collected. A systematic literature search was performed using MEDLINE, Embase, Web of Science and Cochrane Library databases, up to the date of September 1, 2023. In total, 16 studies, encompassing a total of 1,650 cases of uHCC, were included in the final meta-analysis. The pooled conversion rates for LEN alone, LEN + ICI, LEN + LRT and LEN + ICI + LRT were calculated to be 0.04 (95% CI, 0.00-0.07; I2=77%), 0.23 (95% CI, 0.16-0.30; I2=66%), 0.14 (95% CI, 0.10-0.18; I2=0%) and 0.35 (95% CI, 0.23-0.47; I2=88%), respectively. The pooled ORRs for LEN alone, LEN + ICI, LEN + LRT and LEN + ICI + LRT were found to be 0.45 (95% CI, 0.23-0.67; I2=96%), 0.49 (95% CI, 0.39-0.60; I2=78%), 0.43 (95% CI, 0.24-0.62; I2=88%) and 0.69 (95% CI, 0.56-0.82; I2=92%), respectively. The pooled DCRs for LEN alone, LEN + ICI, LEN + LRT and LEN + ICI + LRT were observed to be 0.77 (95% CI, 0.73-0.81; I2=23%), 0.82 (95% CI, 0.69-0.95; I2=90%), 0.67 (95% CI, 0.39-0.94; I2=94%) and 0.87 (95% CI, 0.82-0.93; I2=67%), respectively. The pooled grade ≥3 AEs for LEN alone, LEN + ICI, LEN + LRT and LEN + ICI + LRT were 0.25 (95% CI, 0.14-0.36; I2=89%), 0.43 (95% CI, 0.34-0.53; I2=23%), 0.42 (95% CI, 0.19-0.66; I2=81%) and 0.35 (95% CI, 0.17-0.54; I2=94%), respectively. These findings suggested that LEN-based combination strategies may confer efficacy and acceptable tolerability for patients with uHCC. In particular, LEN + ICI, with or without LRT, appears to represent a highly effective conversion regimen, with an acceptable conversion rate and well-characterized safety profile.