Background: Transarterial chemoembolization (TACE) is the standard treatment for patients with intermediate-stage hepatocellular carcinoma (HCC); however, its survival benefits remain unsatisfactory. In this systematic review, we aimed to compare the clinical outcomes of tyrosine kinase inhibitors (TKIs) combined with TACE and TACE alone in patients with intermediate-stage HCC. Methods: A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. Randomized controlled trials (RCTs) comparing TACE plus TKIs with TACE alone in patients with HCC were retrieved from PubMed, Embase, and the Cochrane Library. The primary outcomes included overall survival (OS) and progression-free survival (PFS), reported as hazard ratios (HRs) with 95% confidence intervals (CIs). Secondary outcomes included the overall response rate (ORR) and disease control rate (DCR), which were analyzed using risk ratios (RRs). Heterogeneity was assessed using theI2statistic. Results: Fourteen RCTs were included in this meta-analysis. Compared to TACE alone, TACE plus TKIs significantly improved PFS (HR = 0.74, 95% CI: 0.59–0.93,p= 0.01,I2= 87%) and the ORR (RR = 1.29, 95% CI: 1.11–1.51,p= 0.001), but not OS (HR = 0.84, 95% CI: 0.69–1.03,p= 0.10,I2= 65%) and the DCR (RR = 1.05, 95% CI: 0.99–1.11,p= 0.08). Subgroup analysis showed that TACE plus TKIs significantly increased OS in patients with hepatitis B virus (HBV) infection (HR = 0.67, 95% CI: 0.51–0.88), but not in those with hepatitis C virus (HCV) infection or those without HBV and HCV infection. Moreover, patients with HBV infection, male patients, and those with a good functional status (ECOG performance status of 0) had better PFS than others. Conclusions: Compared with TACE alone, TACE combined with TKIs can significantly improve PFS and the ORR in patients with intermediate-stage HCC. Furthermore, combination treatment can significantly improve OS in patients with HBV infection, but not in patients with HCV infection. Further research is required to optimize patient selection and treatment strategies.
背景：经动脉化疗栓塞（TACE）是中期肝细胞癌（HCC）患者的标准治疗方法，但其生存获益仍不理想。本系统综述旨在比较酪氨酸激酶抑制剂（TKIs）联合TACE与单纯TACE治疗中期HCC患者的临床结局。 方法：本研究遵循系统综述和荟萃分析优先报告条目指南，进行了系统综述和荟萃分析。从PubMed、Embase和Cochrane图书馆检索了比较TACE联合TKIs与单纯TACE治疗HCC患者的随机对照试验。主要结局指标包括总生存期和无进展生存期，以风险比及其95%置信区间报告。次要结局指标包括客观缓解率和疾病控制率，采用风险比进行分析。使用I²统计量评估异质性。 结果：本荟萃分析共纳入14项随机对照试验。与单纯TACE相比，TACE联合TKIs显著改善了无进展生存期和客观缓解率，但未显著改善总生存期和疾病控制率。亚组分析显示，TACE联合TKIs能显著提高乙型肝炎病毒（HBV）感染患者的总生存期，但对丙型肝炎病毒（HCV）感染患者或无HBV/HCV感染患者则无此效果。此外，HBV感染患者、男性患者以及功能状态良好的患者无进展生存期优于其他患者。 结论：与单纯TACE相比，TACE联合TKIs能显著改善中期HCC患者的无进展生存期和客观缓解率。此外，联合治疗能显著改善HBV感染患者的总生存期，但对HCV感染患者则无此效果。未来需要进一步研究以优化患者选择和治疗策略。
肿瘤(癌症)患者之家