Optimal candidates and surrogate endpoints for HAIC versus Sorafenib in hepatocellular carcinoma: an updated systematic review and meta-analysis.

IF 12.5 2区医学 Q1 SURGERY

International journal of surgery Pub Date : 2024-08-02 DOI:10.1097/JS9.0000000000001889

Tengfei Si, Qing Shao, Wayel Jassem, Yun Ma, Nigel Heaton

{"title":"Optimal candidates and surrogate endpoints for HAIC versus Sorafenib in hepatocellular carcinoma: an updated systematic review and meta-analysis.","authors":"Tengfei Si, Qing Shao, Wayel Jassem, Yun Ma, Nigel Heaton","doi":"10.1097/JS9.0000000000001889","DOIUrl":null,"url":null,"abstract":"Background and aims: Hepatic artery infusion chemotherapy (HAIC) has been a long-standing intervention for hepatocellular carcinoma (HCC). Despite positive clinical outcomes, its inclusion in guidelines remains limited due to a lack of evidence-based support. This study aims to identify optimal target populations for HAIC and validate associations between intermediate endpoints with overall survival (OS).Methods: Following PRISMA guidelines, a comprehensive search was conducted in PubMed, Embase, Cochrane Library, and Web of Science. The primary search strategy was based on medical subject headings terms (MeSH) using \"Hepatic arterial infusion chemotherapy\", \"HAIC\", \"Sorafenib\", \"Nexavar\", \"hepatocellular carcinoma\", \"HCC\", \"Liver cancer\", combined with free text words. Data extraction, quality assessment, and analysis were performed according to pre-registered protocol.Results: A total of 26 studies, 6456 HCC patients were included for analysis (HAIC, n=2648; Sorafenib, n=3808). Pooled outcomes revealed that Sorafenib demonstrated better OS only in patients who were refractory to trans-arterial chemoembolization (TACE) (HR=1.32,95%CI [1.01-1.73]), in other subgroups or overall HCC population HAIC consistently outperformed Sorafenib in patients' survival. Radiologically, higher response rates in the HAIC group does not necessarily translate into survival improvement, but the hazard ratios (HRs) of 1y-OS (R2=0.41, P=0.0044) and 1y-progression free survival (1y-PFS) (R2=0.77, P=0.0002) strongly correlated with the patients OS. Meanwhile, larger tumour size (HR=1.86,95%CI [1.12-3.1, 95%), heavier tumour burden (HR=2.32, 95%CI [1.33-4.02), existence of MVI or EHS (HR=1.65,95%CI[1.36-2]; HR=1.60,95%CI[1.19-2.14]), and AFP >400 ng/mL (HR=1.52, 95%CI [1.20-1.92]) were identified as independent risk factors for OS, while HAIC treatment (HR=0.54, 95%CI[0.35-0.82]) and lower BCLC stage (HR=0.44, 95%CI[0.28-0.69]) were potential protective factors for HCC patients.Conclusion: HAIC monotherapy appears noninferior to Sorafenib in HCC treatment, with potential benefits in specific subgroups. The robust correlation between 1y-OS/1y-PFS and OS, alongside identified risk and protective factors from the present study, offers valuable insights for designing future large prospective studies in this field.","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":null,"pages":null},"PeriodicalIF":12.5000,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International journal of surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/JS9.0000000000001889","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}

引用次数: 0

Abstract

Background and aims: Hepatic artery infusion chemotherapy (HAIC) has been a long-standing intervention for hepatocellular carcinoma (HCC). Despite positive clinical outcomes, its inclusion in guidelines remains limited due to a lack of evidence-based support. This study aims to identify optimal target populations for HAIC and validate associations between intermediate endpoints with overall survival (OS).

Methods: Following PRISMA guidelines, a comprehensive search was conducted in PubMed, Embase, Cochrane Library, and Web of Science. The primary search strategy was based on medical subject headings terms (MeSH) using "Hepatic arterial infusion chemotherapy", "HAIC", "Sorafenib", "Nexavar", "hepatocellular carcinoma", "HCC", "Liver cancer", combined with free text words. Data extraction, quality assessment, and analysis were performed according to pre-registered protocol.

Results: A total of 26 studies, 6456 HCC patients were included for analysis (HAIC, n=2648; Sorafenib, n=3808). Pooled outcomes revealed that Sorafenib demonstrated better OS only in patients who were refractory to trans-arterial chemoembolization (TACE) (HR=1.32,95%CI [1.01-1.73]), in other subgroups or overall HCC population HAIC consistently outperformed Sorafenib in patients' survival. Radiologically, higher response rates in the HAIC group does not necessarily translate into survival improvement, but the hazard ratios (HRs) of 1y-OS (R2=0.41, P=0.0044) and 1y-progression free survival (1y-PFS) (R2=0.77, P=0.0002) strongly correlated with the patients OS. Meanwhile, larger tumour size (HR=1.86,95%CI [1.12-3.1, 95%), heavier tumour burden (HR=2.32, 95%CI [1.33-4.02), existence of MVI or EHS (HR=1.65,95%CI[1.36-2]; HR=1.60,95%CI[1.19-2.14]), and AFP >400 ng/mL (HR=1.52, 95%CI [1.20-1.92]) were identified as independent risk factors for OS, while HAIC treatment (HR=0.54, 95%CI[0.35-0.82]) and lower BCLC stage (HR=0.44, 95%CI[0.28-0.69]) were potential protective factors for HCC patients.

Conclusion: HAIC monotherapy appears noninferior to Sorafenib in HCC treatment, with potential benefits in specific subgroups. The robust correlation between 1y-OS/1y-PFS and OS, alongside identified risk and protective factors from the present study, offers valuable insights for designing future large prospective studies in this field.

查看原文本刊更多论文

HAIC与索拉非尼治疗肝细胞癌的最佳候选者和替代终点：最新系统综述和荟萃分析。

背景和目的：肝动脉灌注化疗（HAIC）是治疗肝细胞癌（HCC）的长期干预措施。尽管临床效果良好，但由于缺乏循证支持，将其纳入指南仍受到限制。本研究旨在确定HAIC的最佳目标人群，并验证中间终点与总生存期（OS）之间的关联：按照 PRISMA 指南，在 PubMed、Embase、Cochrane Library 和 Web of Science 中进行了全面检索。主要检索策略基于医学主题词（MeSH），使用 "肝动脉输注化疗"、"HAIC"、"索拉非尼"、"Nexavar"、"肝细胞癌"、"HCC"、"肝癌"，并结合自由文本词。数据提取、质量评估和分析按照预先登记的方案进行：共纳入26项研究、6456例HCC患者进行分析（HAIC，n=2648；索拉非尼，n=3808）。汇总结果显示，索拉非尼仅在经动脉化疗栓塞（TACE）难治性患者中显示出更好的OS（HR=1.32，95%CI [1.01-1.73]），在其他亚组或整体HCC人群中，HAIC的患者生存率始终优于索拉非尼。从放射学角度看，HAIC组较高的反应率并不一定转化为生存率的提高，但1年生存率（R2=0.41，P=0.0044）和1年无进展生存率（R2=0.77，P=0.0002）的危险比（HRs）与患者的OS密切相关。同时，肿瘤体积较大（HR=1.86，95%CI [1.12-3.1，95%]）、肿瘤负荷较重（HR=2.32，95%CI [1.33-4.02]）、存在 MVI 或 EHS（HR=1.65，95%CI [1.36-2]；HR=1.60，95%CI [1.19-2.14]）和 AFP >400 ng/mL（HR=1.52，95%CI [1.20-1.92]）是OS的独立危险因素，而HAIC治疗（HR=0.54，95%CI[0.35-0.82]）和较低的BCLC分期（HR=0.44，95%CI[0.28-0.69]）是HCC患者的潜在保护因素：结论：在HCC治疗中，HAIC单药治疗效果似乎并不优于索拉非尼，但在特定亚组中具有潜在益处。1y-OS/1y-PFS与OS之间的稳健相关性，以及本研究中发现的风险和保护因素，为设计该领域未来的大型前瞻性研究提供了宝贵的见解。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

International journal of surgery SURGERY-

CiteScore

17.70

自引率

3.30%

发文量

审稿时长

6-12 weeks

期刊介绍： The International Journal of Surgery (IJS) has a broad scope, encompassing all surgical specialties. Its primary objective is to facilitate the exchange of crucial ideas and lines of thought between and across these specialties.By doing so, the journal aims to counter the growing trend of increasing sub-specialization, which can result in "tunnel-vision" and the isolation of significant surgical advancements within specific specialties.

文献相关原料

公司名称	产品信息	采购帮参考价格