Transarterial chemoembolization plus sorafenib for the management of unresectable hepatocellular carcinoma: a systematic review and meta-analysis.
Transarterial chemoembolization plus sorafenib for the management of unresectable hepatocellular carcinoma: a systematic review and meta-analysis.
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经动脉化疗栓塞联合索拉非尼治疗不可切除的肝细胞癌：系统评价和荟萃分析
DOI：
10.1186/s12876-018-0849-0
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发表时间：
2018-09-04
影响因子：
2.4
通讯作者：
Liu L
中科院分区：
文献类型：
--
作者：
Li L;Zhao W;Wang M;Hu J;Wang E;Zhao Y;Liu L
研究背景经动脉化疗栓塞（TACE）是巴塞罗那临床肝癌（BCLC）B期肝细胞癌（HCC）患者的推荐治疗方法，索拉非尼是BCLC C期的口服小分子靶向药物。这一更新的系统回顾和荟萃分析的重点是确定的疗效相结合的TACE索拉非尼，这仍然是有争议的，尽管多年的exploration.MethodsPubMed，EMBASE，Scopus和科克伦图书馆进行了系统的审查，以搜索1990年1月至2017年5月发表的研究。关注联合治疗对不可切除HCC疗效的研究符合条件。收集疾病进展时间（TTP）、总生存期（OS）、疾病控制率（DCR）和病因学的风险比（HR）和95%置信区间（95% CI）。然后使用STATA 13.0通过固定/随机效应荟萃分析模型对数据进行分析。治疗相关的不良事件（AE）的发生率和严重程度也evaluated.ResultsTwenty-seven研究被纳入。13项非比较研究报告了中位OS（范围为18.5 - 20.4个月）、中位TTP（范围为7 - 13.9个月）和DCR（范围为18.4 - 95%）。14项比较研究提供了中位OS（范围为7.0 - 29.7个月）和中位TTP（范围为2.6 - 10.2个月）。5项比较研究提供了DCR（范围为32%至97.2%）。森林图显示，与单纯TACE相比，联合治疗显著改善了TTP（HR = 0.66，95%CI 0.50- 0.81，P = 0.002）而非OS（HR = 0.63，95%CI 0.55- 0.71，P = 0.058）。联合治疗组的DCR显著增加（OR = 2.93，95%CI1.59 - 5.41，P = 0.005）。绘制了额外的森林图，在各种病因之间的生存结局方面没有观察到显著差异。区域单独分析的森林图显示亚洲国家组TTP的HR为0.62（95%CI 0.45- 0.79，P = 0.002），西方国家组为0.82（95%CI 0.59- 1.05，P = 0.504）。亚洲国家组OS的HR为0.61（95%CI 0.48- 0.75，P = 0.050），西方国家组为0.88（95%CI 0.56- 1.20，P = 0.845）。这些数据可能表明亚洲患者的TTP结局为阳性，但欧洲患者未显示，而在两个地区均未观察到OS的阳性结果。最常见的不良事件包括疲劳，手足皮肤反应，腹泻和hypertension.ConclusionsCombination治疗可能有利于不可切除的肝癌患者延长TTP和DCR。需要更多设计良好的研究来研究其对OS的优越性。
BackgroundTransarterial chemoembolization (TACE) is the recommended treatment for hepatocellular carcinoma (HCC) patients at Barcelona Clinic Liver Cancer (BCLC) B-stage, whereas sorafenib is an orally administered small molecule target drug for BCLC C-stage. This updated systemic review and meta-analysis focuses on identifying the efficacy of the combination of TACE with sorafenib, which remains controversial despite years of exploration.MethodsPubMed, EMBASE, Scopus and the Cochrane Library were systematically reviewed to search for studies published from January 1990 to May 2017. Studies focusing on the efficacy of combination therapy for unresectable HCC were eligible. The hazard ratio (HR) with 95% confidence intervals (95% CIs) for time to progression (TTP), overall survival (OS), disease control rate (DCR) and aetiology were collected. The data were then analysed through fixed/random effects meta-analysis models with STATA 13.0. The incidence and severity of treatment-related adverse events (AEs) were also evaluated.ResultsTwenty-seven studies were included. Thirteen non-comparative studies reported median OS (ranging from 18.5 to 20.4 months), median TTP (ranging from 7 to 13.9 months) and DCR (ranging from 18.4 to 95%). Fourteen comparative studies provided median OS (ranging from 7.0 to 29.7 months) and median TTP (ranging from 2.6 to 10.2 months). Five comparative studies provided DCR (ranging from 32 to 97.2%). Forest plots showed that combination therapy significantly improved TTP (HR = 0.66, 95% CI 0.50–0.81,P= 0.002) rather than OS (HR = 0.63, 95% CI 0.55–0.71,P= 0.058), compared to TACE alone. DCR increased significantly in the combination therapy group (OR = 2.93, 95% CI 1.59–5.41,P= 0.005). Additional forest plots were drawn and no significant differences were observed with regard to survival outcome among various aetiologies. Forest plots for separate analysis of regions showed the HR for TTP was 0.62 (95% CI 0.45–0.79,P= 0.002) in the Asian countries group, and 0.82 (95% CI 0.59–1.05,P= 0.504)) in western countries. The HR for OS was 0.61 (95% CI 0.48–0.75,P= 0.050) in the Asian countries group and was 0.88 (95% CI 0.56–1.20,P= 0.845) in western countries. These data may indicate positive TTP outcome in Asian patients but not in European patients while no positive findings regarding OS were observed in either region. The most common AEs included fatigue, hand-foot skin reaction, diarrhoea and hypertension.ConclusionsCombination therapy may benefit unresectable HCC patients in terms of prolonged TTP and DCR. More well-designed studies are needed to investigate its superiority for OS.
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影响因子：
7.6
作者：
Cabrera R;Pannu DS;Caridi J;Firpi RJ;Soldevila-Pico C;Morelli G;Clark V;Suman A;George TJ Jr;Nelson DR
通讯作者：
Nelson DR
影响因子：
25.7
作者：
Lencioni, Riccardo;Llovet, Josep M.;Bruix, Jordi
通讯作者：
Bruix, Jordi
影响因子：
3
作者：
Erhardt, Andreas;Kolligs, Frank;Haussinger, Dieter
通讯作者：
Haussinger, Dieter
影响因子：
2.4
作者：
Muhammad, Adnan;Dhamija, Manish;Kumar, Ambuj
通讯作者：
Kumar, Ambuj
影响因子：
2.9
作者：
Hassan, MM;Frome, A;El-Serag, HB
通讯作者：
El-Serag, HB