SYSTEMATIC REVIEW article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1577614
This article is part of the Research TopicNovel Therapeutic Approaches for Biliary Tract Cancer and Hepatocellular Carcinoma, Volume IIView all 3 articles
Efficacy of Therapies in Intermediate Stage Hepatocellular Carcinoma: Systematic Review and Network Meta-analysis
Provisionally accepted
Shaoqi Zong1*
Yifan Yang1Zifei Yin2Lanyun Feng1Kun Wang1
Zhen Chen1
Hao Chen1
Zhiqiang Meng1Yongqiang Hua1- 1Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, Shanghai Municipality, China
- 2Naval Medical University, Shanghai, Shanghai, China
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Background: Trans-arterial chemoembolization (TACE) is recommended for intermediate-stage hepatocellular carcinoma (HCC). However, several therapies have shown better efficacy than TACE, meaning the optimal therapy is unclear. We addressed this uncertainty using network meta-analysis (NMA).We performed literature review up to March 15, 2024, efficacy was evaluated using overall survival (OS) and progression free survival (PFS), the hazard ratios (HRs) and 95% confidence intervals (CIs) were extracted from Kaplan-Meier curves, randomeffects NMA was conducted, subgroup analysis was performed according to tumor number, tumor size, viral etiology, AFP level. The efficacy of different therapies is ranked based on P-score.Results: A total of 38 studies, 10972 patients, and 13 therapeutic regimens were eligible.Seven therapies showed OS benefit over TACE, including TACE plus microwave ablation (MWA) (HR = 0.24, 95% CI = 0.06-0.91), TACE plus liver resection (HR = 0.35, 95% CI = 0.22-0.57), liver resection plus TACE (HR = 0.39, 95% CI = 0.23-0.65); liver resection plus TACE (HR = 0.49, 95% CI = 0.35-0.70); TACE plus ICIs plus TKIs (HR = 0.51, 95% CI = 0.27-0.95); liver resection (HR = 0.54, 95% CI = 0.45-0.65); TACE plus RFA (HR = 0.57, 95% CI = 0.36-0.93). While no therapies improved PFS better than TACE alone. Subgroup analysis showed that Liver resection plus TACE showed the best OS for patients with HBV infection.Conclusions: Seven therapies had better efficacy than TACE alone for particular intermediate-stage HCC patients.
Keywords: Intermediate stage, Hepatocellular Carcinoma, TACE, efficacy, Network meta-analysis
Received: 16 Feb 2025; Accepted: 16 Jun 2025.
Copyright: © 2025 Zong, Yang, Yin, Feng, Wang, Chen, Chen, Meng and Hua. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Shaoqi Zong, Department of Integrative Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, Shanghai Municipality, China
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