What question did this study set out to answer?

To evaluate the efficacy and safety of interventional therapy combined with immune checkpoint inhibitors in hepatocellular carcinoma.

February 9, 2026Open Access

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

Key Points

To evaluate the efficacy and safety of interventional therapy combined with immune checkpoint inhibitors in hepatocellular carcinoma.
Conducted systematic search across multiple databases to identify relevant studies.
Performed single-arm and Bayesian network meta-analyses.
Assessed progression-free survival, overall survival, objective response rate, and adverse events.
Combination TACE-TKI-Tisle showed median progression-free survival of 11.7 months.
TACE-TKI-Tisle had an objective response rate of 72% and a grade ≥ 3 adverse event rate of 24%.
Network meta-analysis indicated TACE-TKI-Tisle and TACE-TKI-Tori had the highest efficacy rankings.

Abstract

Abstract 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.

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