阿特唑单抗/贝伐单抗治疗肝细胞癌患者出血风险：系统评价和荟萃分析

IF 11.6 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Liver Cancer Pub Date : 2024-05-22 eCollection Date: 2024-12-01 DOI:10.1159/000539423

Young-Gi Song, Kyeong-Min Yeom, Eun Ae Jung, Sang Gyune Kim, Young Seok Kim, Jeong-Ju Yoo

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引用次数: 0

摘要

导语：atezolizumab/bevacizumab联合治疗已成为晚期肝细胞癌（HCC）的有效一线治疗方法。然而，这种疗法可能与出血并发症相关，需要对其发生率和严重程度进行全面分析。本荟萃分析旨在综合来自临床试验和观察性研究的现有证据，以量化阿特唑单抗/贝伐单抗给药后出血的发生率。方法：本荟萃分析侧重于使用atezolizumab/bevacizumab治疗HCC，特别是检查出血并发症。它确定了给药后出血的发生率，并比较了酪氨酸激酶抑制剂（索拉非尼或lenvatinib）的风险比。出血并发症的危险因素也进行了评估。结果：28项研究涉及3,895例患者，出血副作用的总发生率为8.42% （95% CI: 5.72-11.54）。4.42% （95% CI: 2.64-6.10）的患者出现III级或IV级出血，2.06% （95% CI: 0.56-4.22）的患者出现V级出血。以静脉曲张为主的消化道出血最为常见，患病率为5.48% （95% CI: 3.98-7.17）。亚组分析显示，根据研究设计和地理位置，出血率存在差异。与酪氨酸激酶抑制剂相比，Atezolizumab/bevacizumab治疗的出血发生率高2.11倍（95% CI: 1.21-3.66）。meta回归发现，高身体质量指数（BMI）和较高比例的白蛋白-胆红素（ALBI） 3级是出血并发症的重要危险因素。结论：Atezolizumab/bevacizumab治疗晚期HCC具有更高的胃肠道出血风险，超过酪氨酸激酶抑制剂。高BMI和高ALBI分级是出血并发症的关键预测因素，强调了谨慎选择和监测患者的必要性。

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Risk of Bleeding in Hepatocellular Carcinoma Patients Treated with Atezolizumab/Bevacizumab: A Systematic Review and Meta-Analysis.

Introduction: The combination of atezolizumab/bevacizumab has emerged as an effective first-line treatment for advanced hepatocellular carcinoma (HCC). However, this therapy is potentially associated with bleeding complications, warranting a comprehensive analysis of their incidence and severity. This meta-analysis aims to synthesize available evidence from clinical trials and observational studies to quantify the prevalence of bleeding following atezolizumab/bevacizumab administration.

Methods: This meta-analysis focused on HCC treatment using atezolizumab/bevacizumab, particularly examining bleeding complications. It determined the prevalence of bleeding post-administration and compared the risk ratio with tyrosine kinase inhibitors (sorafenib or lenvatinib). Risk factors for bleeding complications were also evaluated.

Results: From 28 studies involving 3,895 patients, the pooled prevalence of bleeding side effects was 8.42% (95% CI: 5.72-11.54). Grade III or IV bleeding occurred in 4.42% (95% CI: 2.64-6.10) of patients, with grade V bleeding observed in 2.06% (95% CI: 0.56-4.22). Gastrointestinal bleeding, predominantly variceal, was the most common, with a prevalence of 5.48% (95% CI: 3.98-7.17). Subgroup analysis indicated variability in bleeding rates based on study design and geographical location. Atezolizumab/bevacizumab treatment exhibited a 2.11 times higher prevalence of bleeding compared to tyrosine kinase inhibitors (95% CI: 1.21-3.66). Meta-regression identified high body mass index (BMI) and higher proportion of albumin-bilirubin (ALBI) grade 3 as significant risk factors for bleeding complications.

Conclusion: Atezolizumab/bevacizumab therapy for advanced HCC carries a heightened risk of gastrointestinal bleeding, exceeding that of tyrosine kinase inhibitors. High BMI and higher ALBI grade are key predictors of bleeding complications, emphasizing the need for cautious patient selection and monitoring.

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来源期刊

Liver Cancer Medicine-Oncology

CiteScore

20.80

自引率

7.20%

发文量

审稿时长

16 weeks

期刊介绍： Liver Cancer is a journal that serves the international community of researchers and clinicians by providing a platform for research results related to the causes, mechanisms, and therapy of liver cancer. It focuses on molecular carcinogenesis, prevention, surveillance, diagnosis, and treatment, including molecular targeted therapy. The journal publishes clinical and translational research in the field of liver cancer in both humans and experimental models. It publishes original and review articles and has an Impact Factor of 13.8. The journal is indexed and abstracted in various platforms including PubMed, PubMed Central, Web of Science, Science Citation Index, Science Citation Index Expanded, Google Scholar, DOAJ, Chemical Abstracts Service, Scopus, Embase, Pathway Studio, and WorldCat.