Outcome of patients with HCC and liver dysfunction under immunotherapy: a systematic review and meta-analysis

医学 内科学 免疫疗法 胃肠病学 荟萃分析 结果(博弈论) 肿瘤科 癌症 数理经济学 数学
作者
Ismael El Hajra,Marco Sanduzzi‐Zamparelli,Víctor Sapena,Sergio Muñoz,Ezequiel Mauro,Neus Llarch,Gemma Iserte,Alejandro Forner,José Ríos,Jordi Bruix,María Reig
出处
期刊:Hepatology [Lippincott Williams & Wilkins]
卷期号:77 (4): 1139-1149 被引量:21
标识
DOI:10.1097/hep.0000000000000030
摘要

Background and Aims: Immunotherapy-based regimes have changed the management of HCC. However, evidence of efficacy in patients with impaired liver function is unknown. This systematic review and meta-analysis assesses survival of HCC patients and liver dysfunction treated with immunotherapy-based regimens. Methods: Systematic review and meta-analysis of original articles or abstracts reporting survival of HCC patients treated with immunotherapy according to liver function between 2017 and 2022. Overal survival (OS) according to restricted mean survival time (RMST) and median OS, and hazard ratio (HR) of Child-Pugh B or B/C versus Child-Pugh A were assessed while considering the line of treatment. Results: Of the 2218 articles considered, 15 articles recruiting 2311 patients were included. Of these, 639 (27.7%) were Child-Pugh B and 34 (1.5%) C. RMST was 8.36 (95% CI, 6.15–10.57; I 2 =93%) months, estimated from 8 studies. The HR was reported in 8 studies for survival between Child-Pugh B versus Child-Pugh A and metanalysis disclosed a 1.65 HR (95% CI,1.45–1.84; I 2 =0% heterogeneity; p = 0.45). Treatment line data were available for 47% of the patients and 3 studies included patients treated with atezolizumab-bevacizumab in the first line. Conclusions: The high heterogeneity across studies reflects the incapacity of the current evidence to support the indication of immunotherapy in HCC patients with relevant liver dysfunction. It is mandatory to report complementary information to Child-Pugh classification such as prior liver decompensation, use of concomitant medication to control ascites, or signs of clinically significant portal hypertension to allow better patient stratification in future studies.
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