{"title":"中晚期肝细胞癌局部和全身治疗的最佳排序：网络荟萃分析。","authors":"Wei Lu, Zhiyuan Li, Chen Pan, Bingliang Chen, Gang Zhang, Zhiming Yang, Jingcheng Hao","doi":"10.1007/s00432-025-06233-7","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Transarterial chemoembolization (TACE), anti-angiogenic drugs (AADs), and immune checkpoint inhibitors (ICIs) are common therapies for hepatocellular carcinoma (HCC). Despite proven benefits of combined regimens, optimal sequencing remains unclear. This network meta-analysis evaluates safety and efficacy of therapeutic sequences in intermediate-advanced HCC.</p><p><strong>Methods: </strong>We conducted a comprehensive search of multiple databases, including PubMed, Cochrane Library, Web of Science, and EMBASE, for studies published until February 1, 2025. Cochrane's tools and the Newcastle-Ottawa Scale were used to assess the evaluation of bias. We performed data compilation and conducted a network meta-analysis to compare the relative efficacy of different treatments.</p><p><strong>Results: </strong>A total of 56 studies (10,456 patients) evaluated 11 therapeutic sequences. Survival outcomes favored TACE-AADs-ICIs (TAI), which ranked highest for overall survival (OS: SUCRA 90.0%) and progression-free survival (PFS: SUCRA 91.3%). Tumor responses differed significantly across regimens: TACE-ICIs (TI) achieved the highest probability of complete response rate (CRR: SUCRA 83.9%), while AADs-ICIs-TACE (AIT) ranked first in objective response rate (ORR: SUCRA 85.8%). Notably, ICIs-AADs (IA) achieved superior disease control rate (DCR: SUCRA 88.1%). ICIs monotherapy (I) was associated with the lowest incidence of grade ≥ 3 adverse events (AEs: SUCRA 11.7%).</p><p><strong>Conclusion: </strong>Our comprehensive network meta-analysis establishes a multidimensional efficacy-safety profile for sequential therapies in intermediate and advanced HCC management. TACE-initiated sequences (TAI/TIA) optimize survival (OS/PFS: SUCRA > 90%), while systemic-first regimens (AIT/IA) maximize tumor response (ORR/DCR: SUCRA > 85%). ICIs monotherapy exhibits the safest profile. Further clinical studies are warranted to determine optimal treatment sequencing for intermediate and advanced HCC.</p>","PeriodicalId":15118,"journal":{"name":"Journal of Cancer Research and Clinical Oncology","volume":"151 6","pages":"196"},"PeriodicalIF":2.7000,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Optimal sequencing of locoregional and systemic therapies for intermediate and advanced hepatocellular carcinoma: a network meta-analysis.\",\"authors\":\"Wei Lu, Zhiyuan Li, Chen Pan, Bingliang Chen, Gang Zhang, Zhiming Yang, Jingcheng Hao\",\"doi\":\"10.1007/s00432-025-06233-7\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Transarterial chemoembolization (TACE), anti-angiogenic drugs (AADs), and immune checkpoint inhibitors (ICIs) are common therapies for hepatocellular carcinoma (HCC). Despite proven benefits of combined regimens, optimal sequencing remains unclear. This network meta-analysis evaluates safety and efficacy of therapeutic sequences in intermediate-advanced HCC.</p><p><strong>Methods: </strong>We conducted a comprehensive search of multiple databases, including PubMed, Cochrane Library, Web of Science, and EMBASE, for studies published until February 1, 2025. Cochrane's tools and the Newcastle-Ottawa Scale were used to assess the evaluation of bias. We performed data compilation and conducted a network meta-analysis to compare the relative efficacy of different treatments.</p><p><strong>Results: </strong>A total of 56 studies (10,456 patients) evaluated 11 therapeutic sequences. Survival outcomes favored TACE-AADs-ICIs (TAI), which ranked highest for overall survival (OS: SUCRA 90.0%) and progression-free survival (PFS: SUCRA 91.3%). Tumor responses differed significantly across regimens: TACE-ICIs (TI) achieved the highest probability of complete response rate (CRR: SUCRA 83.9%), while AADs-ICIs-TACE (AIT) ranked first in objective response rate (ORR: SUCRA 85.8%). Notably, ICIs-AADs (IA) achieved superior disease control rate (DCR: SUCRA 88.1%). ICIs monotherapy (I) was associated with the lowest incidence of grade ≥ 3 adverse events (AEs: SUCRA 11.7%).</p><p><strong>Conclusion: </strong>Our comprehensive network meta-analysis establishes a multidimensional efficacy-safety profile for sequential therapies in intermediate and advanced HCC management. TACE-initiated sequences (TAI/TIA) optimize survival (OS/PFS: SUCRA > 90%), while systemic-first regimens (AIT/IA) maximize tumor response (ORR/DCR: SUCRA > 85%). ICIs monotherapy exhibits the safest profile. Further clinical studies are warranted to determine optimal treatment sequencing for intermediate and advanced HCC.</p>\",\"PeriodicalId\":15118,\"journal\":{\"name\":\"Journal of Cancer Research and Clinical Oncology\",\"volume\":\"151 6\",\"pages\":\"196\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-06-25\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Cancer Research and Clinical Oncology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00432-025-06233-7\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Cancer Research and Clinical Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00432-025-06233-7","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"ONCOLOGY","Score":null,"Total":0}
Optimal sequencing of locoregional and systemic therapies for intermediate and advanced hepatocellular carcinoma: a network meta-analysis.
Introduction: Transarterial chemoembolization (TACE), anti-angiogenic drugs (AADs), and immune checkpoint inhibitors (ICIs) are common therapies for hepatocellular carcinoma (HCC). Despite proven benefits of combined regimens, optimal sequencing remains unclear. This network meta-analysis evaluates safety and efficacy of therapeutic sequences in intermediate-advanced HCC.
Methods: We conducted a comprehensive search of multiple databases, including PubMed, Cochrane Library, Web of Science, and EMBASE, for studies published until February 1, 2025. Cochrane's tools and the Newcastle-Ottawa Scale were used to assess the evaluation of bias. We performed data compilation and conducted a network meta-analysis to compare the relative efficacy of different treatments.
Results: A total of 56 studies (10,456 patients) evaluated 11 therapeutic sequences. Survival outcomes favored TACE-AADs-ICIs (TAI), which ranked highest for overall survival (OS: SUCRA 90.0%) and progression-free survival (PFS: SUCRA 91.3%). Tumor responses differed significantly across regimens: TACE-ICIs (TI) achieved the highest probability of complete response rate (CRR: SUCRA 83.9%), while AADs-ICIs-TACE (AIT) ranked first in objective response rate (ORR: SUCRA 85.8%). Notably, ICIs-AADs (IA) achieved superior disease control rate (DCR: SUCRA 88.1%). ICIs monotherapy (I) was associated with the lowest incidence of grade ≥ 3 adverse events (AEs: SUCRA 11.7%).
Conclusion: Our comprehensive network meta-analysis establishes a multidimensional efficacy-safety profile for sequential therapies in intermediate and advanced HCC management. TACE-initiated sequences (TAI/TIA) optimize survival (OS/PFS: SUCRA > 90%), while systemic-first regimens (AIT/IA) maximize tumor response (ORR/DCR: SUCRA > 85%). ICIs monotherapy exhibits the safest profile. Further clinical studies are warranted to determine optimal treatment sequencing for intermediate and advanced HCC.
期刊介绍：
The "Journal of Cancer Research and Clinical Oncology" publishes significant and up-to-date articles within the fields of experimental and clinical oncology. The journal, which is chiefly devoted to Original papers, also includes Reviews as well as Editorials and Guest editorials on current, controversial topics. The section Letters to the editors provides a forum for a rapid exchange of comments and information concerning previously published papers and topics of current interest. Meeting reports provide current information on the latest results presented at important congresses.
The following fields are covered: carcinogenesis - etiology, mechanisms; molecular biology; recent developments in tumor therapy; general diagnosis; laboratory diagnosis; diagnostic and experimental pathology; oncologic surgery; and epidemiology.
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