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Background <p>Combining interventional therapy with immune checkpoint inhibitors (ICIs) has shown potential benefits in hepatocellular carcinoma (HCC). However, comprehensive evidence on its efficacy and safety remains limited.</p> Methods <p>A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted to identify eligible studies for single-arm and Bayesian network meta-analyses (NMA). Progression-free survival (PFS) was the primary endpoint, while overall survival (OS), objective response rate (ORR), and grade ≥ 3 adverse events (AEs) were secondary outcomes (PROSPERO: CRD42024619661).</p> Findings <p>This study included 45 studies (n = 4,738), evaluating 14 distinct regimens. In single-arm analysis, transcatheter arterial chemoembolization (TACE) plus tyrosine-kinase inhibitor (TKI) plus tislelizumab [TACE-TKI-Tisle] yielded a pooled median PFS of 11.7&#xa0;months (95% confidence interval [CI] 8.02–15.37), an ORR of 72% (95% CI 63–80%), and a grade ≥ 3 AE rate of 24% (95% CI 15–34%). NMA showed that TACE-TKI-Tisle and TACE-TKI-Camrelizumab (Camre) achieved significantly longer PFS than TACE-TKI or TACE alone. TACE-TKI-Toripalimab (Tori) showed OS benefits over TACE-TKI-Camre (HR = 0.43; 95% CI 0.20–0.95) and TACE-TKI-Pembrolizumab (Pembro) (HR = 0.32; 95% CI 0.13–0.81). Cumulative ranking via surface under the cumulative ranking curve (SUCRA) indicated that TACE-TKI-ICI achieved the highest efficacy ranking. TACE-TKI-Tisle and TACE-TKI-Tori ranked highest for PFS/ORR, with TACE-TKI-Tori ranking first for OS (SUCRA = 0.981). While TACE-TKI-ICI combinations were generally associated with more grade ≥ 3 AEs, TACE-TKI-Tisle ranked intermediately for safety (SUCRA = 0.426).</p> Conclusion <p>TACE-TKI-ICI combinations show promising efficacy in HCC. TACE-TKI-Tisle offers balanced efficacy and safety, while TACE-TKI-Tori provides notable OS benefits, warranting further validation in prospective studies.</p>

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Comparative efficacy of combination regimens based on interventional therapy and immune checkpoint inhibitors (ICIs) in patients with intermediate- and advanced-stage hepatocellular carcinoma: a systematic review, meta-analysis, and network meta-analysis

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  • 出版模式：

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  • 发表日期：

    2026年2月7日

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  • Jingting Su,
  • Yuejiao Su,
  • Rongyun Mai,
  • Xing Gao,
  • Shizhou Li,
  • Dandan Zeng,
  • Weijie Cen,
  • Zhenbo Huang,
  • Xiaoqing Li,
  • Haoyu Zeng,
  • Wenbing Li,
  • Can Zeng,
  • Tianzhun Wu,
  • Kaixiang Mo,
  • Jiazhou Ye,
  • Yan Lin,
  • Rong Liang

摘要

Background

Combining interventional therapy with immune checkpoint inhibitors (ICIs) has shown potential benefits in hepatocellular carcinoma (HCC). However, comprehensive evidence on its efficacy and safety remains limited.

Methods

A systematic search of PubMed, Embase, Cochrane Library, and Web of Science was conducted to identify eligible studies for single-arm and Bayesian network meta-analyses (NMA). Progression-free survival (PFS) was the primary endpoint, while overall survival (OS), objective response rate (ORR), and grade ≥ 3 adverse events (AEs) were secondary outcomes (PROSPERO: CRD42024619661).

Findings

This study included 45 studies (n = 4,738), evaluating 14 distinct regimens. In single-arm analysis, transcatheter arterial chemoembolization (TACE) plus tyrosine-kinase inhibitor (TKI) plus tislelizumab [TACE-TKI-Tisle] yielded a pooled median PFS of 11.7 months (95% confidence interval [CI] 8.02–15.37), an ORR of 72% (95% CI 63–80%), and a grade ≥ 3 AE rate of 24% (95% CI 15–34%). NMA showed that TACE-TKI-Tisle and TACE-TKI-Camrelizumab (Camre) achieved significantly longer PFS than TACE-TKI or TACE alone. TACE-TKI-Toripalimab (Tori) showed OS benefits over TACE-TKI-Camre (HR = 0.43; 95% CI 0.20–0.95) and TACE-TKI-Pembrolizumab (Pembro) (HR = 0.32; 95% CI 0.13–0.81). Cumulative ranking via surface under the cumulative ranking curve (SUCRA) indicated that TACE-TKI-ICI achieved the highest efficacy ranking. TACE-TKI-Tisle and TACE-TKI-Tori ranked highest for PFS/ORR, with TACE-TKI-Tori ranking first for OS (SUCRA = 0.981). While TACE-TKI-ICI combinations were generally associated with more grade ≥ 3 AEs, TACE-TKI-Tisle ranked intermediately for safety (SUCRA = 0.426).

Conclusion

TACE-TKI-ICI combinations show promising efficacy in HCC. TACE-TKI-Tisle offers balanced efficacy and safety, while TACE-TKI-Tori provides notable OS benefits, warranting further validation in prospective studies.