基于病因的晚期肝细胞癌全身治疗的疗效：随机III期试验的系统回顾和网络荟萃分析

IF 5.5 2区医学 Q1 HEMATOLOGY

Critical reviews in oncology/hematology Pub Date : 2025-07-09 DOI:10.1016/j.critrevonc.2025.104842

Charlene Hoi Lam Wong , Kenneth Sik Kwan Chan , Regina Cheuk Lam Lo , Chi Leung Chiang

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引用次数: 0

摘要

背景：目前缺乏基于病因的肝细胞癌（HCC）治疗效果的可靠对比数据。我们进行了一项网络荟萃分析（NMA）和两两荟萃分析，以评估基于病因接受全身治疗的晚期HCC患者的生存率。方法系统检索2009年1月1日至2024年6月6日的spubmed /MEDLINE Ovid、Embase、Cochrane Library、CINAHL数据库和试验注册库的相关研究。招募了三种病因亚组（乙型肝炎病毒和lt；乙型肝炎病毒和lt；丙型肝炎病毒和lt；丙型肝炎病毒和lt； hcv和lt；或非病毒性病因）中至少一种报告生存结果的晚期HCC患者进行全身治疗的III期随机对照试验。使用频率NMA评估治疗的比较有效性，并使用p值对治疗的有效性进行排序。采用合并风险比（hr）和95% %置信区间（ci）的随机效应两两荟萃分析来量化治疗的效果。主要终点是总生存期（OS），次要终点是无进展生存期（PFS）。结果共纳入29项随机对照试验，共18229例患者。在一线试验中。Atezolizumab + 贝伐珠单抗（atezo-bev）（P-score, 87 %）和STRIDE （P-score, 75 %）在所有批准的HBV人群方案中获得最佳的OS获益；atezo-bev （P-score, 94 %）在HCV患者中排名最佳。对于非病毒病原学，STRIDE （P-score, 79 %）排名最佳，而atezo-bev （P-score, 29 %）排名最差。配对MA显示，ICI + VEGF/VEGFRi在不同病因（HBV: 0.65, HCV: 0.72，非病毒：0.98,p = 0.01）与对照组（索拉非尼）相比，HR有显著差异，而ICI在不同病因（HBV: 0.81, HCV: 0.79，非病毒：0.83,p = 0.94）与对照组相比HR一致。结论原发性肝病影响晚期肝癌的治疗效果。ICI + VEGF/VEGFRi的生存获益主要见于病毒性hcc。

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Efficacy of systemic therapy for advanced hepatocellular carcinoma based on etiology: A systematic review and network meta-analysis of randomized phase III trials

Background

Robust comparative data on the treatment efficacy of hepatocellular carcinoma (HCC) based on disease etiology are lacking. We conducted a network meta-analysis (NMA) and pairwise meta-analysis to evaluate the survival of patients with advanced HCC treated with systemic therapies based on etiology.

Methods

PubMed/MEDLINE Ovid, Embase, Cochrane Library, CINAHL Databases, and trial registries were systematically searched for relevant studies from 1 January 2009 and 6 June 2024. Phase III randomized controlled trials of systemic therapies in advanced HCC patients with survival outcomes reported in at least one of the three etiology subgroups (hepatitis B virus <HBV>, hepatitis C virus <HCV>, or non-viral etiology) were recruited. Frequentist NMA was used to evaluate the comparative effectiveness of treatments and the P-score to rank the effectiveness of the treatments. A random-effects pairwise meta-analysis with pooled hazard ratios (HRs) and 95 % confidence intervals (CIs) was used to quantify the effect of treatments. The primary outcome was overall survival (OS) and the secondary outcome was progression free survival (PFS).

Results

A total of 29 RCTs encompassing 18,229 patients were included. In first-line trials. Atezolizumab + bevacizumab (atezo-bev) (P-score, 87 %) and STRIDE (P-score, 75 %) yielded the best OS benefits among all approved regimens in the HBV population; atezo-bev (P-score, 94 %) ranked the best in HCV patients. For non-viral aetiology, STRIDE (P-score, 79 %) ranked the best whereas atezo-bev (P-score, 29 %) ranked the worst. Pairwise MA showed that ICI + VEGF/VEGFRi has significantly different HR compared to control (sorafenib) in different etiology (HBV: 0.65, HCV: 0.72, and non-viral: 0.98, p = 0.01), while ICI has consistent HR compared to control irrespective of disease etiology (HBV: 0.81, HCV: 0.79, non-viral: 0.83, p = 0.94).

Conclusion

Treatment efficacy of advanced HCC is affected by underlying liver disease. The survival benefit of ICI + VEGF/VEGFRi was mainly seen in viral-HCC.

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来源期刊

Critical reviews in oncology/hematology 医学-血液学

CiteScore

11.00

自引率

3.20%

发文量

213

审稿时长

55 days

期刊介绍： Critical Reviews in Oncology/Hematology publishes scholarly, critical reviews in all fields of oncology and hematology written by experts from around the world. Critical Reviews in Oncology/Hematology is the Official Journal of the European School of Oncology (ESO) and the International Society of Liquid Biopsy.