PMID- 37843788
OWN - NLM
STAT- MEDLINE
DCOM- 20240415
LR  - 20240415
IS  - 1936-0541 (Electronic)
IS  - 1936-0533 (Linking)
VI  - 18
IP  - 2
DP  - 2024 Apr
TI  - TACE plus tyrosine kinase inhibitors and immune checkpoint inhibitors versus TACE 
      plus tyrosine kinase inhibitors for the treatment of patients with hepatocellular 
      carcinoma: a meta-analysis and trial sequential analysis.
PG  - 595-609
LID - 10.1007/s12072-023-10591-0 [doi]
AB  - BACKGROUND: We conducted a meta-analysis and trial sequential analysis (TSA) to 
      compare the therapeutic efficacy and adverse events (AEs) between the following 
      treatment strategies for patients with hepatocellular carcinoma (HCC): TACE plus 
      tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) 
      (TACE + T + I) versus TACE plus TKIs (TACE + T). METHODS: We systematically 
      searched PubMed, the Web of Science, the Cochrane Library, and Embase for studies 
      comparing TACE + T + I and TACE + T for the treatment of BCLC intermediate- or 
      advanced-stage HCC. The objective response rate (ORR), progression-free survival 
      (PFS), overall survival (OS), and AEs were included as outcomes. We used a fixed- 
      or random-effects model based on the results of a heterogeneity evaluation and 
      performed a meta-analysis using Review Manager 5.3 and Stata 16.0. We then 
      carried out the TSA. RESULTS: Five studies examining a total of 425 patients were 
      included in this study. Our meta-analysis revealed that, compared to TACE + T, 
      TACE + T + I significantly improved the ORR (risk ratio [RR] = 1.53, 95% 
      confidence interval [CI] = 1.27-1.85, p < 0.01) and extended both the median PFS 
      (mean difference [MD] = 4.51 months, 95% CI = 2.16-6.87, p < 0.01) and median OS 
      (MD = 5.75 months, 95% CI = 4.03-7.48, p < 0.01). These results were tested to be 
      true by the TSA without requiring a larger information size. Among AEs, 
      hypertension tended to occur more often in patients treated with TACE + T + I 
      than in those treated with TACE + T (RR = 1.58, 95% CI = 1.05-2.40, p < 0.05). 
      However, the TSA suggested that additional cases are necessary to confirm this 
      difference. Regarding the other AEs, no significant differences were detected 
      between the two groups. CONCLUSION: TACE + T + I showed better effects on the 
      ORR, PFS, and OS than TACE + T as a treatment for BCLC stages B and C HCC, 
      without an obvious increase in the AEs. Based on these findings, well-designed, 
      large RCTs are suggested.
CI  - (c) 2023. Asian Pacific Association for the Study of the Liver.
FAU - Liu, Jiaxi
AU  - Liu J
AD  - Department of Interventional Radiology, The First Hospital of China Medical 
      University, No.155 Nanjing Road, Heping District, Shenyang, 110001, Liaoning, 
      China.
FAU - Wang, Peng
AU  - Wang P
AD  - Department of Interventional Radiology, The First Hospital of China Medical 
      University, No.155 Nanjing Road, Heping District, Shenyang, 110001, Liaoning, 
      China.
FAU - Shang, Liqi
AU  - Shang L
AD  - Department of Interventional Radiology, The First Hospital of China Medical 
      University, No.155 Nanjing Road, Heping District, Shenyang, 110001, Liaoning, 
      China.
FAU - Zhang, Zhoubo
AU  - Zhang Z
AD  - Department of Interventional Radiology, The First Hospital of China Medical 
      University, No.155 Nanjing Road, Heping District, Shenyang, 110001, Liaoning, 
      China.
FAU - Tian, Yulong
AU  - Tian Y
AD  - Department of Interventional Radiology, The First Hospital of China Medical 
      University, No.155 Nanjing Road, Heping District, Shenyang, 110001, Liaoning, 
      China.
FAU - Chen, Xiaowei
AU  - Chen X
AD  - Department of Interventional Radiology, The First Hospital of China Medical 
      University, No.155 Nanjing Road, Heping District, Shenyang, 110001, Liaoning, 
      China.
FAU - Ma, Yanan
AU  - Ma Y
AD  - Department of Biostatistics and Epidemiology, School of Public Health, China 
      Medical University, Shenyang, Liaoning, China. ynma@cmu.edu.cn.
FAU - Shao, Haibo
AU  - Shao H
AD  - Department of Interventional Radiology, The First Hospital of China Medical 
      University, No.155 Nanjing Road, Heping District, Shenyang, 110001, Liaoning, 
      China. hbshao@cmu.edu.cn.
LA  - eng
GR  - No.82072037/National Natural Science Foundation of China/
GR  - 82111530100/National Natural Science Foundation of China/
GR  - 2022-YGJC-53/Liaoning Medical-Engineering Cross Fund/
GR  - No.2012AA022701/National Hi-Technology Research and Development Program/
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20231016
PL  - United States
TA  - Hepatol Int
JT  - Hepatology international
JID - 101304009
RN  - 0 (Immune Checkpoint Inhibitors)
RN  - 0 (Tyrosine Kinase Inhibitors)
SB  - IM
CIN - Hepatol Int. 2024 Feb 8;:. PMID: 38329702
MH  - Humans
MH  - *Carcinoma, Hepatocellular/pathology
MH  - *Liver Neoplasms/pathology
MH  - Immune Checkpoint Inhibitors/therapeutic use
MH  - Tyrosine Kinase Inhibitors
MH  - *Chemoembolization, Therapeutic/methods
OTO - NOTNLM
OT  - Hepatocellular carcinoma
OT  - Immune checkpoint inhibitors
OT  - Meta-analysis
OT  - TACE
OT  - Trial sequential analysis
OT  - Tyrosine kinase inhibitors
EDAT- 2023/10/16 12:42
MHDA- 2024/04/15 06:43
CRDT- 2023/10/16 11:14
PHST- 2023/05/14 00:00 [received]
PHST- 2023/08/29 00:00 [accepted]
PHST- 2024/04/15 06:43 [medline]
PHST- 2023/10/16 12:42 [pubmed]
PHST- 2023/10/16 11:14 [entrez]
AID - 10.1007/s12072-023-10591-0 [pii]
AID - 10.1007/s12072-023-10591-0 [doi]
PST - ppublish
SO  - Hepatol Int. 2024 Apr;18(2):595-609. doi: 10.1007/s12072-023-10591-0. Epub 2023 
      Oct 16.