Introduction
Materials and methodology
Literature search
Inclusion and exclusion criteria
Inclusion criteria
Exclusion criteria
Data extraction
Literature quality assessment
Statistical analysis methods
Results
Retrieval results and fundamental characteristics of the literature
Study | Year | Country | Diagnosis | Type | Sample size | Gender (M/F) | Mean age (years) | Child–Pugh(A/B) | Intervention | Follow-up Time (months) | Outcome |
---|---|---|---|---|---|---|---|---|---|---|---|
Shuguang Ju [20] | 2021 | China | unresectable HCC | RCT | 52 | 44/8 | 55 | 41/11 | camrelizumab + apatinib | 13.5 | ORR, DCR, mPFS, mOS, AEs |
Guosheng Yuan [25] | 2021 | China | unresectable HCC | A single-arm study | 86 | 72/14 | 55 | 64/22 | camrelizumab + apatinib | NR | ORR, DCR, AEs |
Jianming Xu [21] | 2021 | China | advanced HCC | A single-arm study | 190 | 169/21 | 53 | 162/28 | camrelizumab + apatinib | 16.7 | ORR, mPFS, AEs |
Zhiming Zeng [23] | 2021 | China | advanced liver cancer | A single-arm study | 45 | 35/10 | 52 | 38/7 | camrelizumab + apatinib | NR | ORR, DCR, AEs |
Yongxiang Xia [24] | 2022 | China | HCC | A single-arm study | 18 | 17/1 | 54.7 | NR | camrelizumab + apatinib | NR | ORR, AEs |
Kuimin Mei [22] | 2021 | China | advanced primary liver cancer | A single-arm study | 21 | 18/3 | 48 | 20/1 | camrelizumab + apatinib | 12.4 | ORR, DCR, mOS, mPFS, AEs |
Jianming Xu [19] | 2019 | China | advanced HCC | A single-arm study | 18 | 17/1 | 49 | 13/5 | camrelizumab + apatinib | 7.9 | ORR, DCR mPFS, AEs |
Guosheng Yuan [26] | 2020 | China | HCC | A single-arm study | 63 | 58/5 | 48 | 54/9 | camrelizumab + apatinib | 12.6 | ORR, DCR, mPFS, AEs |
Shukui Qin [27] | 2023 | China | unresectable or metastatic HCC | RCT | 272 | 227/45 | 58 | 236/36 | camrelizumab + apatinib | 14.5 | ORR, mPFS, mOS, AEs |
Dongbo Chen [28] | 2023 | China | HCC | A single-arm study | 86 | 77/9 | 57 | NR | camrelizumab + apatinib | 13.5 | ORR, DCR, mPFS, mOS, AEs |
Literature quality assessment
Study | I | II | III | IV | V | VI | VII | VIII | Total |
---|---|---|---|---|---|---|---|---|---|
Shuguang Ju (2021) [20] | 2 | 2 | 2 | 2 | 2 | 2 | 2 | 1 | 15 |
Guosheng Yuan (2021) [25] | 2 | 2 | 1 | 2 | 2 | 1 | 2 | 1 | 13 |
Jianming Xu (2021) [21] | 2 | 2 | 2 | 2 | 1 | 2 | 2 | 1 | 14 |
Zhiming Zeng (2021) [23] | 2 | 2 | 1 | 2 | 1 | 1 | 2 | 2 | 13 |
Yongxiang Xia (2022) [24] | 2 | 2 | 1 | 2 | 2 | 1 | 1 | 1 | 12 |
Kuimin Mei (2021) [22] | 2 | 2 | 1 | 2 | 1 | 2 | 1 | 2 | 13 |
Jianming Xu (2019) [19] | 2 | 2 | 1 | 2 | 1 | 2 | 1 | 2 | 13 |
Guosheng Yuan (2020) [26] | 2 | 2 | 2 | 2 | 1 | 2 | 1 | 2 | 14 |
Shukui Qin (2023) [27] | 2 | 2 | 1 | 2 | 2 | 2 | 2 | 2 | 15 |
Dongbo Chen (2023) [28] | 2 | 2 | 1 | 2 | 2 | 1 | 2 | 2 | 14 |
Therapeutic efficacy indicators
Objective Response Rate (ORR)
Disease Control Rate (DCR)
Median Progression-Free Survival (mPFS)
Median Overall Survival (mOS)
Safety
adverse event | Any grade | Grade ≥ 3 | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
study | Heterogeneity | ES (95%CI) | P | P(Egger) | study | Heterogeneity | ES (95%CI) | P | P(Egger) | |||
P | I2(%) | P | I2(%) | |||||||||
Total | 6 | 0.000 | 92.8 | 0.90(0.85,0.95) | 0.000 | 0.420 | 6 | 0.000 | 97.7 | 0.49(0.27,0.71) | 0.000 | 0.250 |
Thrombocytopenia | 3 | 0.031 | 71.3 | 0.51(0.41,0.62) | 0.000 | 0.020 | 3 | 0.000 | 88.7 | 0.09(0.01,0.17) | 0.034 | 0.277 |
Hypertension | 7 | 0.000 | 95.6 | 0.45(0.27,0.62) | 0.000 | 0.829 | 5 | 0.000 | 98.5 | 0.19(0.04,0.34) | 0.011 | 0.063 |
Hand-foot skin reaction | 5 | 0.000 | 84.1 | 0.45(0.33,0.57) | 0.000 | 0.201 | 4 | 0.218 | 32.4 | 0.06(0.03,0.09) | 0.000 | 0.693 |
Leukopenia | 3 | 0.001 | 85.8 | 0.40(0.26,0.55) | 0.000 | 0.422 | NR | |||||
Abdominal pain | 4 | 0.017 | 70.7 | 0.34(0.24,0.44) | 0.000 | 0.421 | 3 | 0.466 | 0.00 | 0.02(0.00,0.03) | 0.017 | 0.323 |
Proteinuria | 6 | 0.000 | 97.1 | 0.37(0.17,0.56) | 0.000 | 0.797 | 4 | 0.114 | 49.7 | 0.05(0.02,0.07) | 0.000 | 0.906 |
Diarrhea | 3 | 0.711 | 0.0 | 0.31(0.26,0.36) | 0.000 | 0.203 | 2 | 0.661 | 0.0 | 0.02(0.00,0.04) | 0.015 | - |
Hepatotoxicity | 2 | 0.000 | 97.8 | 0.24(0.18,0.66) | 0.260 | - | 2 | 0.589 | 0.0 | 0.03(0.01,0.06) | 0.003 | - |
Fever | 2 | 0.003 | 88.7 | 0.20(0.15,0.54) | 0.261 | - | NR | |||||
Hypothyroidism | 6 | 0.000 | 85.2 | 0.20(0.12,0.27) | 0.000 | 0.616 | NR | |||||
Rash | 5 | 0.000 | 87.8 | 0.18(0.09,0.27) | 0.000 | 0.653 | 4 | 0.195 | 36.2 | 0.01(0.00,0.03) | 0.057 | 0.088 |
Fatigue | 4 | 0.163 | 41.4 | 0.17(0.11,0.22) | 0.000 | 0.843 | NR | |||||
RCCEP | 4 | 0.003 | 78.3 | 0.19(0.10,0.27) | 0.000 | 0.295 | NR | |||||
Nausea and vomiting | 3 | 0.885 | 0.0 | 0.11(0.08,0.14) | 0.000 | 0.453 | NR |
Outcome | Study | Factor | Heterogeneity | P | SE | |
---|---|---|---|---|---|---|
P | I2(%) | |||||
AEs (any grade) | 6 | Study Type | 0.000 | 92.8 | 0.939 | -0.0281683 to 0.0304537 |
AEs(grade ≥ 3) | 6 | Study Type | 0.000 | 97.7 | 0.229 | -0.2439073 to 1.020582 |
Publication bias analysis
Outcome | Study | Heterogeneity | ES (95%CI) | P | P(Egger) | |
---|---|---|---|---|---|---|
P | I2(%) | |||||
ORR (%) | 10 | 0.013 | 56.9 | 0.28(0.23,0.34) | 0.000 | 0.268 |
DCR (%) | 7 | 0.195 | 30.5 | 0.69(0.64,0.73) | 0.000 | 0.068 |
mPFS(months) | 7 | 0.001 | 73.1 | 5.87(4.96,6.78) | 0.000 | 0.469 |
mOS(months) | 3 | 0.137 | 49.7 | 19.35(17.53,21.17) | 0.000 | 0.828 |
AEs (any grade, %) | 6 | 0.000 | 92.8 | 0.90(0.85,0.95) | 0.000 | 0.420 |
AEs (grade ≥ 3, %) | 6 | 0.000 | 97.7 | 0.49(0.27,0.71) | 0.000 | 0.250 |