Integrating Quality of Life and Survival in Systemic Therapy for Advanced Hepatocellular Carcinoma: A Network Meta-Analysis.

While overall survivalremains the primary efficacy end point, health-related quality of life (HR-QoL) represents a crucial complementary outcome that has not been comprehensively compared across available treatments.

虽然总生存期仍然是主要的有效性终点，但健康相关生活质量（HR-QoL）代表了一个至关重要的补充结果，尚未在现有治疗方案中进行全面比较。

Background

To compare the HR-QoL effects associated with different first-line treatments for unresectable or advanced HCC and to integrate treatment-induced survival benefit with impact on patients' HR-QoL.

比较不同一线治疗对不可切除或晚期肝细胞癌（HCC）患者健康相关生活质量（HR-QoL）的影响，并将治疗引起的生存益处与对患者HR-QoL的影响相结合。

data_sources

The MEDLINE, CENTRAL, and Scopus databases were systematically searched for studies published from inception through November 2024.

通过MEDLINE、CENTRAL和Scopus数据库系统检索了自创刊至2024年11月发表的研究。

The search was supplemented with manual reviews of reference lists and abstracts from main oncology conferences from the past 5 years (2020-2024).

通过手动审查过去5年（2020-2024年）主要肿瘤学会议的参考文献列表和摘要来补充搜索。

study_selection

Phase 3 randomized clinical trials comparing tyrosine kinase inhibitor monotherapy to immune checkpoint inhibitor-based therapies in first-line advanced HCC and reporting HR-QoL deterioration were included.

纳入了比较酪氨酸激酶抑制剂单药治疗与基于免疫检查点抑制剂的疗法在一线晚期HCC中的III期随机临床试验，并报告了健康相关生活质量（HR-QoL）恶化的研究。

data_extraction_and_synthesis

Study selection and data extraction were performed by 2 independent reviewers, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

研究选择和数据提取由2名独立评审员根据系统评价和荟萃分析报告首选项目指南进行。

The Cochrane Collaboration tool was used to assess risk of bias.

使用Cochrane协作工具评估偏倚风险。

A bayesian network meta-analysiswas performed using sorafenib as the comparator.

使用索拉非尼作为对照进行了贝叶斯网络荟萃分析。

main_outcomes_and_measures

Time to deterioration of HR-QoL domains were assessed using the European Organization for Research and Treatment of Cancer's Quality-of-Life Questionnaire Core 30 and HCC18.

使用欧洲癌症研究与治疗组织的核心生活质量问卷30和HCC18评估了健康相关生活质量（HR-QoL）领域的恶化时间。

Treatment ranking was calculated using surface under the cumulative ranking (SUCRA) for HR-QoL items.

治疗排名是通过累积排名曲线下面积（SUCRA）计算得出，针对健康相关生活质量（HR-QoL）项目。

Results

Seven HR-QoL items from 9 randomized clinical trials enrolling 6425 patients met inclusion criteria.

来自9项随机临床试验的7个健康相关生活质量（HR-QoL）项目，共有6425名患者符合纳入标准。

SUCRA calculations showed that atezolizumab plus bevacizumab had the highest probability of reducing deterioration of global health status and QoL (85%), abdominal swelling (95%), jaundice (89%), and pain (86%).

SUCRA计算显示，阿替利珠单抗联合贝伐珠单抗在减少整体健康状况和生活质量恶化（85%）、腹部肿胀（95%）、黄疸（89%）和疼痛（86%）方面具有最高的概率。

When integrating HR-QoL with overall survival, atezolizumab plus bevacizumab outperformed all other treatments across all items.

在将健康相关生活质量与总生存期相结合时，阿替利珠单抗联合贝伐珠单抗在所有项目上均优于其他所有治疗方法。

conclusions_and_relevance

This network meta-analysisfound that atezolizumab plus bevacizumab provides the best balance between QoL preservation and overall survivalbenefit compared to other systemic therapy options in unresectable or advanced HCC.

这项网络荟萃分析发现，与不可切除或晚期HCC的其他系统治疗方案相比，阿替利珠单抗联合贝伐珠单抗在生活质量维持和总生存获益之间提供了最佳平衡。

This integrated assessment of survival and quality of life outcomes offers a more patient-centered approach for treatment selection in clinical practice.

这种生存和生活质量结果的综合评估为临床实践中治疗选择提供了一种更加以患者为中心的方法。