PMID- 35004289
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220429
IS  - 2234-943X (Print)
IS  - 2234-943X (Electronic)
IS  - 2234-943X (Linking)
VI  - 11
DP  - 2021
TI  - First-Line Systemic Treatment Strategies for Unresectable Hepatocellular 
      Carcinoma: A Systematic Review and Network Meta-Analysis of Randomized Clinical 
      Trials.
PG  - 771045
LID - 10.3389/fonc.2021.771045 [doi]
LID - 771045
AB  - OBJECTIVE: Several new first-line treatments were recently approved for 
      unresectable hepatocellular carcinoma (HCC). In this meta-analysis, we compare 
      the efficacy and safety of first-line systemic treatments to provide information 
      for clinical decision making in unresectable HCC. METHODS: Pubmed, Science 
      Direct, Web of Science, Scopus, Ovid MEDLINE, Embase, Google Scholar, the 
      Cochrane Library, EMbase, CNKI, CBM, VIP, and the Wanfang databases, as well as 
      the Cochrane Central Register of Controlled Trails were searched for randomized 
      clinical trials evaluating the efficacy of first-line chemotherapy, molecular 
      targeted therapy, or immunotherapy for unresectable HCC. Hazard ratios with 95% 
      confidence intervals (CIs) were calculated to explore the effects of various 
      treatment options on overall survival (OS) and progression-free survival (PFS), 
      whereas odd ratios with 95% CIs were used for adverse events (AEs) and serious 
      adverse events (SAEs). A network meta-analysis was performed to synthesize data 
      and for direct and indirect comparisons between treatments. The cumulative 
      ranking curve (SUCRA) and P score were used to rank treatments. The risk of bias 
      across studies was assessed graphically and numerically using the funnel plot and 
      Egger's regression test. RESULTS: Fifteen studies including 9005 patients were 
      analyzed. Sintilimab plus bevacizumab, atezolizumab plus bevacizumab, and 
      donafenib had better OS outcomes than sorafenib. Sintilimab plus bevacizumab, 
      atezolizumab plus bevacizumab, lenvatinib, and linifanib had better PFS outcomes 
      than sorafenib. The results of network meta-analysis showed that sintilimab plus 
      bevacizumab was associated with the best OS and PFS. Egger's tests indicated that 
      none of the included studies had obvious publication deviation. CONCLUSION: 
      Sintilimab plus bevacizumab showed the best OS and PFS outcomes with no 
      additional AEs or SAEs. Thus, sintilimab plus bevacizumab may be a better first 
      line choice for the treatment of patients with unresectable HCC. SYSTEMATIC 
      REVIEW REGISTRATION: PROSPEROI [https://www.crd.york.ac.uk/PROSPERO/index.php], 
      identifier CRD42021269734.
CI  - Copyright (c) 2021 Liu, Quan, Lu, Tang, Li, Chen, Ren and Yin.
FAU - Liu, Wenfeng
AU  - Liu W
AD  - Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
AD  - National Clinical Research Center for Interventional Medicine, Zhongshan 
      Hospital, Fudan University, Shanghai, China.
FAU - Quan, Bing
AU  - Quan B
AD  - Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
AD  - National Clinical Research Center for Interventional Medicine, Zhongshan 
      Hospital, Fudan University, Shanghai, China.
FAU - Lu, Shenxin
AU  - Lu S
AD  - Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
AD  - National Clinical Research Center for Interventional Medicine, Zhongshan 
      Hospital, Fudan University, Shanghai, China.
FAU - Tang, Bei
AU  - Tang B
AD  - Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
AD  - National Clinical Research Center for Interventional Medicine, Zhongshan 
      Hospital, Fudan University, Shanghai, China.
FAU - Li, Miao
AU  - Li M
AD  - Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
AD  - National Clinical Research Center for Interventional Medicine, Zhongshan 
      Hospital, Fudan University, Shanghai, China.
FAU - Chen, Rongxin
AU  - Chen R
AD  - Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
AD  - National Clinical Research Center for Interventional Medicine, Zhongshan 
      Hospital, Fudan University, Shanghai, China.
FAU - Ren, Zhenggang
AU  - Ren Z
AD  - Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
AD  - National Clinical Research Center for Interventional Medicine, Zhongshan 
      Hospital, Fudan University, Shanghai, China.
FAU - Yin, Xin
AU  - Yin X
AD  - Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.
AD  - National Clinical Research Center for Interventional Medicine, Zhongshan 
      Hospital, Fudan University, Shanghai, China.
LA  - eng
PT  - Systematic Review
DEP - 20211224
PL  - Switzerland
TA  - Front Oncol
JT  - Frontiers in oncology
JID - 101568867
PMC - PMC8739799
OTO - NOTNLM
OT  - first line systemic therapy
OT  - network meta-analysis
OT  - randomized clinical trials
OT  - systematic review
OT  - unresectable hepatocellular carcinoma
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2022/01/11 06:00
MHDA- 2022/01/11 06:01
PMCR- 2021/01/01
CRDT- 2022/01/10 09:23
PHST- 2021/09/06 00:00 [received]
PHST- 2021/12/09 00:00 [accepted]
PHST- 2022/01/10 09:23 [entrez]
PHST- 2022/01/11 06:00 [pubmed]
PHST- 2022/01/11 06:01 [medline]
PHST- 2021/01/01 00:00 [pmc-release]
AID - 10.3389/fonc.2021.771045 [doi]
PST - epublish
SO  - Front Oncol. 2021 Dec 24;11:771045. doi: 10.3389/fonc.2021.771045. eCollection 
      2021.