PMID- 36300147
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20221028
IS  - 2415-1289 (Electronic)
IS  - 2415-1289 (Linking)
VI  - 7
DP  - 2022
TI  - Identifying optimal therapies in patients with advanced hepatocellular carcinoma: 
      a systematic review and network meta-analysis.
PG  - 38
LID - 10.21037/tgh-20-318 [doi]
LID - 38
AB  - BACKGROUND: Recently, increasing literature has been reported on optimal 
      therapies in patients with advanced hepatocellular carcinoma (HCC) and many 
      therapeutic modalities have been proposed to improve the survival rate. However, 
      the results are not consistent due to different research protocols, small sample 
      sizes and different study endpoints and there is no standard treatment protocol 
      has been defined. Therefore, it is very important to explore the optimal bonding 
      mode and to evaluate the efficacy and safety of the optimal sequential therapy 
      for those patients. METHODS: We searched available databases through January 2020 
      for relevant studies. The main outcome measure was 1-year overall survival (OS) 
      and overall response rate (ORR); the secondary outcome measure was a composite of 
      toxic effects retrieved grade 3 or 4 adverse events (AEs) from all included 
      studies. Statistical analyses were conducted using STATA version 15 and GeMTC 
      package in the R statistical software. RESULTS: After a detailed review, 8 
      randomized controlled trials (RCTs) and 20 retrospective studies involving 3,675 
      advanced HCC patients were included for network meta-analysis. Indirect 
      comparisons showed that hepatic arterial infusion chemotherapy (HAIC) plus 
      radiofrequency ablation (RFA) was highest probability of obtaining the best OS 
      rate of 1 year [surface under the cumulative ranking (SUCRA), 0.95] and ORR 
      (SUCRA, 0.86) when compared with other potential optimal therapies and which had 
      ranked the first in all treatment regimens, followed by HAIC (SUCRA, 0.75). 
      Direct and indirect comparison of 1-year OS and ORR with all treatment regimens 
      each other showed that for all treatment regimens, patients showed significant 
      clinical benefit when compared with transcatheter arterial chemoembolization 
      (TACE) or sorafenib alone. However, the incidence of treatment-related AEs of 
      grade 3 or 4 occurred in patients who have received targeted drug sorafenib 
      therapy (SUCRA, 0.51) compared with other interesting regimens. CONCLUSIONS: HAIC 
      may be a valuable therapeutic strategy for advanced HCC patients to prevent 
      recurrence and metastasis after RFA, as well as in improving patient prognosis 
      and quality of life. Meanwhile, HAIC combined with RFA is a safe and effective 
      treatment in patients with advanced HCC, and this combination therapy can 
      significantly prolong 1-year survival rate when compared with other optimal 
      sequential therapies. TRIAL REGISTRATION: This study is registered with PROSPERO, 
      number CRD42020176149.
CI  - 2022 Translational Gastroenterology and Hepatology. All rights reserved.
FAU - Yang, Zhenyu
AU  - Yang Z
AD  - Department of General Surgery, Tangdu Hospital, Air Force Military Medical 
      University, Xi'an, China.
FAU - Tong, Yao
AU  - Tong Y
AD  - Department of Anesthesiology, Tangdu Hospital, Air Force Military Medical 
      University, Xi'an, China.
FAU - Yang, Lin
AU  - Yang L
AD  - Department of General Surgery, Tangdu Hospital, Air Force Military Medical 
      University, Xi'an, China.
FAU - He, Xianli
AU  - He X
AD  - Department of General Surgery, Tangdu Hospital, Air Force Military Medical 
      University, Xi'an, China.
FAU - Bao, Guoqiang
AU  - Bao G
AD  - Department of General Surgery, Tangdu Hospital, Air Force Military Medical 
      University, Xi'an, China.
FAU - Du, Xilin
AU  - Du X
AD  - Department of General Surgery, Tangdu Hospital, Air Force Military Medical 
      University, Xi'an, China.
LA  - eng
PT  - Journal Article
DEP - 20221025
PL  - China
TA  - Transl Gastroenterol Hepatol
JT  - Translational gastroenterology and hepatology
JID - 101683450
PMC - PMC9468989
OTO - NOTNLM
OT  - Advanced hepatocellular carcinoma (advanced HCC)
OT  - network meta-analysis
OT  - optimal sequential therapy
OT  - survival analysis
COIS- Conflicts of Interest: All authors have completed the ICMJE uniform disclosure 
      form (available at 
      https://tgh.amegroups.com/article/view/10.21037/tgh-20-318/coif). The authors 
      have no conflicts of interest to declare.
EDAT- 2022/10/28 06:00
MHDA- 2022/10/28 06:01
PMCR- 2022/10/25
CRDT- 2022/10/27 02:44
PHST- 2020/10/14 00:00 [received]
PHST- 2021/01/28 00:00 [accepted]
PHST- 2022/10/27 02:44 [entrez]
PHST- 2022/10/28 06:00 [pubmed]
PHST- 2022/10/28 06:01 [medline]
PHST- 2022/10/25 00:00 [pmc-release]
AID - tgh-07-20-318 [pii]
AID - 10.21037/tgh-20-318 [doi]
PST - epublish
SO  - Transl Gastroenterol Hepatol. 2022 Oct 25;7:38. doi: 10.21037/tgh-20-318. 
      eCollection 2022.