A Network Meta-Analysis Comparing the Efficacy of Lenvatinib, Atezolizumab plus Bevacizumab, and Sorafenib in the Treatment of Unresectable Hepatocellular Carcinoma.

Q2 Medicine

Asian Pacific Journal of Cancer Prevention Pub Date : 2026-04-01 DOI:10.31557/APJCP.2026.27.4.1377

Ni Putu Sri Indrani Remitha, I Gede Aswin Parisya Sasmana, I Komang Wira Ananta Kusuma, Christo Timothy Mamangdean, I Gede Putu Supadmanaba, Dwijo Anargha Sindhughosa, I Ketut Mariadi

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引用次数: 0

Abstract

Introduction: Globally, hepatocellular carcinoma (HCC) ranks as the third most common cause of cancer-related death. The five-year overall survival (OS) rate for patients with unresectable HCC is only 12%. Currently, systemic therapies have become the primary treatment options for unresectable hepatocellular carcinoma. Studies comparing the efficacy of first-line treatments including lenvatinib, atezolizumab plus bevacizumab, and sorafenib have shown inconsistent results. There remains a need for updated comparative evidence on cross-mechanism therapy regimens for unresectable disease, as existing findings are still not completely clear. This network meta-analysis aims to provide clearer insights into which treatment offers greater efficacy for patients with unresectable HCC.

Methods: This study was conducted following the 2022 PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Literature searches were performed using PubMed, ScienceDirect, Google Scholar, the Cochrane Library, SpringerLink, and EBSCO to gather studies comparing lenvatinib, atezolizumab plus bevacizumab, and sorafenib for the management of unresectable HCC. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). Overall survival (OS) was analyzed using R statistical software (version 4.4.0).

Results: Eleven studies reporting overall survival (OS) were included in the OS analysis comparing lenvatinib, atezolizumab plus bevacizumab, and sorafenib in the treatment of unresectable HCC. The network meta-analysis showed no significant OS differences between atezolizumab plus bevacizumab and lenvatinib (HR: 0.98; 95% CI: 0.24-4.10) or sorafenib (HR: 1.4; 95% CI: 0.21-9.87). Furthermore, there was no significant difference in OS between lenvatinib and sorafenib (HR: 1.41; 95% CI: 0.38-5.14). Based on the SUCRA plot in this meta-analysis, atezolizumab plus bevacizumab showed the highest probability of being ranked first among the three therapies. Lenvatinib had the highest probability of being ranked second, while sorafenib was more likely to be ranked third.

Conclusion: Atezolizumab plus bevacizumab, lenvatinib, and sorafenib demonstrated similar therapeutic efficacy based on overall survival. Although the hazard ratios (HRs) were not statistically significant, the SUCRA ranking suggested a clinical trend favoring atezolizumab plus bevacizumab.

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Lenvatinib， Atezolizumab + Bevacizumab和Sorafenib治疗不可切除肝细胞癌的疗效比较网络meta分析。

导言：在全球范围内，肝细胞癌（HCC）是癌症相关死亡的第三大常见原因。不可切除HCC患者的5年总生存率（OS）仅为12%。目前，全身治疗已成为不可切除的肝细胞癌的主要治疗选择。比较lenvatinib、atezolizumab + bevacizumab和sorafenib等一线治疗疗效的研究显示出不一致的结果。对于不可切除疾病的跨机制治疗方案，仍然需要更新的比较证据，因为现有的发现仍然不完全清楚。该网络荟萃分析旨在更清楚地了解哪种治疗方法对不可切除的HCC患者更有效。方法：本研究遵循2022 PRISMA指南（系统评价和荟萃分析的首选报告项目）进行。使用PubMed、ScienceDirect、谷歌Scholar、Cochrane Library、SpringerLink和EBSCO进行文献检索，收集比较lenvatinib、atezolizumab + bevacizumab和sorafenib治疗不可切除HCC的研究。采用纽卡斯尔-渥太华量表(NOS)评估偏倚风险。采用R统计软件（4.4.0版）分析总生存期（OS）。结果：11项报告总生存期（OS）的研究被纳入OS分析，比较lenvatinib、atezolizumab + bevacizumab和sorafenib治疗不可切除的HCC。网络荟萃分析显示，atezolizumab +贝伐单抗与lenvatinib （HR: 0.98; 95% CI: 0.24-4.10）或sorafenib （HR: 1.4; 95% CI: 0.21-9.87）之间的OS无显著差异。此外，lenvatinib和sorafenib的OS无显著差异（HR: 1.41; 95% CI: 0.38-5.14）。根据本荟萃分析的SUCRA图，atezolizumab + bevacizumab在三种治疗中排名第一的概率最高。Lenvatinib最有可能排名第二，而sorafenib更有可能排名第三。结论：基于总生存期，Atezolizumab与贝伐单抗、lenvatinib和sorafenib表现出相似的治疗效果。尽管风险比（hr）没有统计学意义，但SUCRA排名表明，临床趋势倾向于阿特唑单抗和贝伐单抗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Asian Pacific Journal of Cancer Prevention 医学-肿瘤学

CiteScore

2.80

自引率

0.00%

发文量

779

审稿时长

3 months

期刊介绍： Cancer is a very complex disease. While many aspects of carcinoge-nesis and oncogenesis are known, cancer control and prevention at the community level is however still in its infancy. Much more work needs to be done and many more steps need to be taken before effective strategies are developed. The multidisciplinary approaches and efforts to understand and control cancer in an effective and efficient manner, require highly trained scientists in all branches of the cancer sciences, from cellular and molecular aspects to patient care and palliation. The Asia Pacific Organization for Cancer Prevention (APOCP) and its official publication, the Asia Pacific Journal of Cancer Prevention (APJCP), have served the community of cancer scientists very well and intends to continue to serve in this capacity to the best of its abilities. One of the objectives of the APOCP is to provide all relevant and current scientific information on the whole spectrum of cancer sciences. They aim to do this by providing a forum for communication and propagation of original and innovative research findings that have relevance to understanding the etiology, progression, treatment, and survival of patients, through their journal. The APJCP with its distinguished, diverse, and Asia-wide team of editors, reviewers, and readers, ensure the highest standards of research communication within the cancer sciences community across Asia as well as globally. The APJCP publishes original research results under the following categories: -Epidemiology, detection and screening. -Cellular research and bio-markers. -Identification of bio-targets and agents with novel mechanisms of action. -Optimal clinical use of existing anti-cancer agents, including combination therapies. -Radiation and surgery. -Palliative care. -Patient adherence, quality of life, satisfaction. -Health economic evaluations.