背景:随着肝细胞癌(HCC)系统治疗的快速发展,结合肝动脉灌注化疗(HAIC)和系统治疗的治疗策略增加了浓度。然而,尚无系统评价比较HAIC及其联合治疗方案在晚期HCC一线治疗中的应用.
目的:探讨HAIC及其联合治疗晚期HCC的疗效和安全性。
方法:进行网络荟萃分析,包括9项随机对照试验和35项队列研究。感兴趣的结果包括总生存期(OS),无进展生存期(PFS),肿瘤反应和不良事件。计算具有95%置信区间(CI)的危险比(HR)和比值比(OR),并根据其排名概率对药物进行排名。
结果:HAIC优于索拉非尼(HR=0.55,95CI:0.42-0.72;HR=0.51,95CI:0.33-0.78;OR=2.86,95CI:1.37-5.98;OR=5.45,95CI:3.57-8.30;OR=7.15,95CI:2.95-0.58;OR=2.95-0.71-2.95HAIC+乐伐替尼+消融,HAIC+消融,HAIC+抗程序性细胞死亡1(PD-1),与单独使用HAIC相比,HAIC+放疗提供更好OS和PFS结局的可能性更高.HAIC+TACE+S-1,HAIC+乐伐替尼,HAIC+PD-1,HAIC+TACE,与HAIC相比,HAIC+索拉非尼提供更好的部分缓解和客观缓解率结果的可能性更高.与单独使用HAIC相比,HAIC+PD-1、HAIC+TACE+S-1和HAIC+TACE提供更好的完全缓解和疾病控制率结果的可能性更高。
结论:HAIC被证明比索拉非尼和TACE更有效和更安全。此外,结合其他干预措施,根据治疗排序分析,HAIC显示优于HAIC单一疗法的疗效。
BACKGROUND: With the rapid progress of systematic therapy for hepatocellular carcinoma (HCC), therapeutic strategies combining hepatic arterial infusion chemotherapy (HAIC) with systematic therapy arised increasing concentrations. However, there have been no systematic review comparing HAIC and its combination strategies in the first-line treatment for advanced HCC.
OBJECTIVE: To investigate the efficacy and safety of HAIC and its combination therapies for advanced HCC.
METHODS: A network meta-analysis was performed by including 9 randomized controlled trails and 35 cohort studies to carry out our study. The outcomes of interest comprised overall survival (OS), progression-free survival (PFS), tumor response and adverse events. Hazard ratios (HR) and odds ratios (OR) with a 95% confidence interval (CI) were calculated and agents were ranked based on their ranking probability.
RESULTS: HAIC outperformed Sorafenib (HR = 0.55, 95%CI: 0.42-0.72; HR = 0.51, 95%CI: 0.33-0.78; OR = 2.86, 95%CI: 1.37-5.98; OR = 5.45, 95%CI: 3.57-8.30; OR = 7.15, 95%CI: 4.06-12.58; OR = 2.89, 95%CI: 1.99-4.19; OR = 0.48, 95%CI: 0.25-0.92, respectively) and transarterial chemoembolization (TACE) (HR = 0.50, 95%CI: 0.33-0.75; HR = 0.62, 95%CI: 0.39-0.98; OR = 3.08, 95%CI: 1.36-6.98; OR = 2.07, 95%CI: 1.54-2.80; OR = 3.16, 95%CI: 1.71-5.85; OR = 2.67, 95%CI: 1.59-4.50; OR = 0.16, 95%CI: 0.05-0.54, respectively) in terms of efficacy and safety. HAIC + lenvatinib + ablation, HAIC + ablation, HAIC + anti- programmed cell death 1 (PD-1), and HAIC + radiotherapy had the higher likelihood of providing better OS and PFS outcomes compared to HAIC alone. HAIC + TACE + S-1, HAIC + lenvatinib, HAIC + PD-1, HAIC + TACE, and HAIC + sorafenib had the higher likelihood of providing better partial response and objective response rate outcomes compared to HAIC. HAIC + PD-1, HAIC + TACE + S-1 and HAIC + TACE had the higher likelihood of providing better complete response and disease control rate outcomes compared to HAIC alone.
CONCLUSIONS: HAIC proved more effective and safer than sorafenib and TACE. Furthermore, combined with other interventions, HAIC showed improved efficacy over HAIC monotherapy according to the treatment ranking analysis.