Network meta-analysis of first-line treatment regimen for hepatocellular carcinoma based on phase Ⅲ RCT data from Chinese population

doi:10.3877/cma.j.issn.2095-3232.2026.04.009

Abstract

Abstract:

Objective

To explore the efficacy and safety of multiple first-line systemic therapies in Chinese patients with advanced hepatocellular carcinoma (HCC).

Methods

Phase Ⅲ RCTs of first-line treatment regimen for advanced HCC reporting Chinese population subgroup data were searched from PubMed, Web of Science and abstracts of important international conferences from the inception date of databases to February 1, 2026. Two independent researchers screened the literature, extracted the data and evaluated the risk of bias. Netmeta package of R software was used for network meta-analysis. HR, OR and 95%CI were calculated. The advantages and disadvantages of each regimen were ranked by using the surface under the cumulative ranking curve (SUCRA).

Results

Twelve phase Ⅲ RCTs were finally included, including 13 study groups, with a total of 4643 patients and 13 treatment regimens. The analysis of clinical efficacy showed that the overall survival (OS) of durvalumab + tremelimumab (HR=0.44, 95%CI: 0.26-0.76) and atezolizumab + bevacizumab (HR=0.44, 95%CI: 0.25-0.77) was significantly better than that of sorafenib (both P<0.05), with higher SUCRA rankings of 86.3% and 86.0%. In terms of progression-free survival (PFS) and objective response rate (ORR), nivolumab + ipilimumab yielded better PFS (HR=0.40, 95%CI: 0.26-0.63) and ORR (OR=11.10, 95%CI: 4.14-29.75) compared with those of sorafenib (all P<0.05), with the highest SUCRA rankings of 90.3% and 82.4%. The safety analysis revealed that the single use of tislelizumab and durvalumab yielded the highest safety in reducing the risk of ≥grade 3 and any grade of treatment-related adverse events. However, camrelizumab+apatinib regimen caused the highest risk of ≥grade 3 TRAE and drug withdrawal.

Conclusions

For Chinese patients with advanced HCC, durvalumab + tremelimumab and atezolizumab + bevacizumab can prolong the OS. Nivolumab + ipilimumab has advantages in controlling disease progression and reducing tumor size, which significantly improves PFS and ORR. However, immune monotherapy with single use of tislelizumab or durvalumab yields high safety.

Key words: Carcinoma,hepatocellular, First-line treatment, Network meta-analysis, Chinese population, Efficacy, Safety

Haibo Li, Yang Li, Tao Zeng, Cheng Feng, Hua Li. Network meta-analysis of first-line treatment regimen for hepatocellular carcinoma based on phase Ⅲ RCT data from Chinese population[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2026, 15(04): 558-567.

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References 35

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