4种一线免疫联合治疗方案用于不可切除肝细胞癌的多准则决策分析  

Multi-criteria decision analysis of four first-line combination immunotherapy for unresectable hepatocellular carcinoma

作　　者：张容容 符宇[3] 赵瑞霞[3] 方雨萱 王靖雯 邵明义[1] ZHANG Rongrong;FU Yu;ZHAO Ruixia;FANG Yuxuan;WANG Jingwen;SHAO Mingyi(Digestive Department,the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China;The First Clinical Medical College of Henan University of Chinese Medicine,Zhengzhou 450046,China;Dept.of Scientific Research,the First Affiliated Hospital of Henan University of Chinese Medicine,Zhengzhou 450000,China)

机构地区：[1]河南中医药大学第一附属医院消化科,郑州450000 [2]河南中医药大学第一临床医学院,郑州450046 [3]河南中医药大学第一附属医院科研部,郑州450000

出　　处：《中国药房》2024年第15期1876-1881,共6页China Pharmacy

基　　金：国家自然科学基金项目(No.82174529);河南省中医药科学研究专项课题(No.20-21ZY1012);河南中医药大学“双一流”创建工程中医学学科项目(No.HSRP-DFCTCM-2023-4-03)。

摘　　要：目的评估4种用于不可切除肝细胞癌的一线免疫联合治疗方案的综合价值,为明确不可切除肝细胞癌的最佳临床治疗决策提供参考。方法采用R4.2软件对4项文献进行网状Meta分析,得到4种联合治疗方案[阿替利珠单抗联合贝伐珠单抗(AB方案)、信迪利单抗联合贝伐珠单抗生物类似物(SB方案)、卡瑞利珠单抗联合阿帕替尼(CA方案)、度伐利尤单抗联合替西木单抗(DT方案)]疗效和安全性指标的效应值;结合疗效、安全性和经济性指标,应用多准则决策分析软件M-MACBETH建立价值树,同时计算4种治疗方案的综合价值总分,采用敏感性分析评价结果的稳健性。结果在延长中位总生存期方面,4种治疗方案的优势排序依次是SB、CA、AB、DT方案;在延长中位无进展生存期方面,优势排序依次是CA、SB、AB、DT方案;在安全性方面,优势排序依次是DT、AB、SB、CA方案;在经济性方面,优势排序依次是CA、SB、AB、DT方案。SB、CA、AB、DT方案的综合价值总分分别为67.11、57.77、52.53、42.59分。敏感性分析结果显示,4种治疗方案的综合价值排名结果较为稳定。结论4种用于不可切除肝细胞癌的一线免疫联合治疗方案中,SB方案为最优治疗方案,而后为CA、AB和DT方案。OBJECTIVE To evaluate the comprehensive value of four first-line combination immunotherapy for unresectable hepatocellular carcinoma,and provide a reference for determining the optimal clinical treatment decision for unresectable hepatocellular carcinoma.METHODS R4.2 software was used for network meta-analysis to obtain the effect values of the efficacy and safety indicators of four combination therapies[atezolizumab combined with bevacizumab(AB),sintilimab combined with bevacizumab biosimilars(SB),camrelizumab combined with apatinib(CA),durvalumab combined with tremelimumab(DT)].Combined with the efficacy,safety and economic indicators,the categorical based evaluation technique(M-MACBETH)was used to establish the value tree.At the same time,the comprehensive value scores of four therapies were calculated,and sensitivity analysis was performed to evaluate the robustness.RESULTS In terms of prolonging median overall survival,the advantage order of the four therapies was ranked as SB,CA,AB and DT.In terms of extending median progression-free survival,the advantage order of the four therapies was CA,SB,AB and DT.In terms of safety,the order of advantages was DT,AB,SB and CA.In terms of economy,the order of advantages was CA,SB,AB and DT.The comprehensive scores of SB,CA,AB and DT were 67.11,57.77,52.53 and 42.59 points,respectively.The results of the sensitivity analysis showed that the ranking results of comprehensive value for four regimens were robust.CONCLUSIONS Among the four first-line immune combination therapies for unresectable hepatocellular carcinoma,SB is the optimal treatment regimen,followed by CA,AB and DT.

关 键 词：不可切除肝细胞癌 免疫联合治疗 多准则决策分析 综合评价 

分 类 号：R979.1[医药卫生—药品]