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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Efficacy of hepatic arterial infusion chemotherapy and its combination strategies for advanced hepatocellular carcinoma: A network meta-analysis
Shun-An Zhou, Qing-Mei Zhou, Lei Wu, Zhi-Hong Chen, Fan Wu, Zhen-Rong Chen, Lian-Qun Xu, Bi-Ling Gan, Hao-Sheng Jin, Ning Shi
Shun-An Zhou, Lian-Qun Xu, Bi-Ling Gan, Hao-Sheng Jin, Ning Shi, Department of General Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510000, Guangdong Province, China
Qing-Mei Zhou, Department of Geriatrics, Ganzhou Hospital-Nanfang Hospital, Southern Medical University, Ganzhou 341000, Jiangxi Province, China
Lei Wu, Fan Wu, Zhen-Rong Chen, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510000, Guangdong Province, China
Zhi-Hong Chen, Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing 100730, China
Co-first authors: Shun-An Zhou and Qing-Mei Zhou.
Co-corresponding authors: Hao-Sheng Jin and Ning Shi.
Author contributions: Zhou SA and Zhou QM contributed equally to this work as co-first authors. Zhou SA, Jin HS, and Shi N designed the research study; Zhou SA, Zhou QM, and Wu L performed the research; Zhou SA, Chen ZH, Wu F, Chen ZR, Xu LQ, Gan BL, and Shi N contributed new reagents and analytic tools; Zhou SA, Wu F, and Shi N analyzed the data and wrote the manuscript; Jin HS and Shi N contributed equally to this work as co-corresponding authors. They supervised the study project, contributed to the conception and design of the study, and played an important role in supervising the manuscript. We believe that designating Jin HS and Shi N as co-corresponding authors is fitting for our manuscript as it accurately reflects our team’s collaborative spirit, equal contributions, and diversity; and all the authors reviewed the various drafts of the manuscript and have approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Ning Shi, FRCS (Gen Surg), Academic Fellow, Department of General Surgery, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 Zhongshan 2
nd Road, Yuexiu District, Guangzhou 510000, Guangdong Province, China.
shining_doc@163.com
Received: April 6, 2024
Revised: June 4, 2024
Accepted: July 5, 2024
Published online: August 15, 2024
Processing time: 123 Days and 19.1 Hours
BACKGROUND
With the rapid progress of systematic therapy for hepatocellular carcinoma (HCC), therapeutic strategies combining hepatic arterial infusion chemotherapy (HAIC) with systematic therapy arised increasing concentrations. However, there have been no systematic review comparing HAIC and its combination strategies in the first-line treatment for advanced HCC.
AIM
To investigate the efficacy and safety of HAIC and its combination therapies for advanced HCC.
METHODS
A network meta-analysis was performed by including 9 randomized controlled trails and 35 cohort studies to carry out our study. The outcomes of interest comprised overall survival (OS), progression-free survival (PFS), tumor response and adverse events. Hazard ratios (HR) and odds ratios (OR) with a 95% confidence interval (CI) were calculated and agents were ranked based on their ranking probability.
RESULTS
HAIC outperformed Sorafenib (HR = 0.55, 95%CI: 0.42-0.72; HR = 0.51, 95%CI: 0.33-0.78; OR = 2.86, 95%CI: 1.37-5.98; OR = 5.45, 95%CI: 3.57-8.30; OR = 7.15, 95%CI: 4.06-12.58; OR = 2.89, 95%CI: 1.99-4.19; OR = 0.48, 95%CI: 0.25-0.92, respectively) and transarterial chemoembolization (TACE) (HR = 0.50, 95%CI: 0.33-0.75; HR = 0.62, 95%CI: 0.39-0.98; OR = 3.08, 95%CI: 1.36-6.98; OR = 2.07, 95%CI: 1.54-2.80; OR = 3.16, 95%CI: 1.71-5.85; OR = 2.67, 95%CI: 1.59-4.50; OR = 0.16, 95%CI: 0.05-0.54, respectively) in terms of efficacy and safety. HAIC + lenvatinib + ablation, HAIC + ablation, HAIC + anti- programmed cell death 1 (PD-1), and HAIC + radiotherapy had the higher likelihood of providing better OS and PFS outcomes compared to HAIC alone. HAIC + TACE + S-1, HAIC + lenvatinib, HAIC + PD-1, HAIC + TACE, and HAIC + sorafenib had the higher likelihood of providing better partial response and objective response rate outcomes compared to HAIC. HAIC + PD-1, HAIC + TACE + S-1 and HAIC + TACE had the higher likelihood of providing better complete response and disease control rate outcomes compared to HAIC alone.
CONCLUSION
HAIC proved more effective and safer than sorafenib and TACE. Furthermore, combined with other interventions, HAIC showed improved efficacy over HAIC monotherapy according to the treatment ranking analysis.
Core Tip: Because there are not enough randomized controlled trials to demonstrate the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) in advanced hepatocellular carcinoma (HCC), HAIC has not yet been recognized in Western countries. Therefore, we conducted a network meta-analysis to compare the safety and efficacy of HAIC and its combination strategies for advanced HCC. Compared to sorafenib and transarterial chemoembolization, HAIC was found to be a better choice in terms of both efficacy and safety. Furthermore, interventions combined with HAIC showed marginally better efficacy compared to HAIC monotherapy.
