| Aims:Primary liver cancer is the fourth common malignant tumor and the second cause of cancer death in China.Since primary liver cancer（especially hepatocellular carcinoma in this paper）has no obvious symptoms in the early stage of onset,most patients with liver cancer have entered the middle and late stage when diagnosed,lost the opportunity of radical resection,and the expected survival time and quality are poor.In recent years,with the continuous application of new technologies and drugs,the treatment of liver cancer has also ushered in new progress.TACE and HAIC can reduce the tumor load.Through HAIC and tare treatment,or combined with external irradiation and stereotactic radiotherapy,it is expected to realize the regression of liver cancer thrombus combined with large vessel tumor thrombus,and create conditions for surgical resection and interventional therapy.The emergence of new models of systemic treatment such as tyrosine kinase inhibitors（TKIs）combined with immune checkpoint inhibitors（ICIS）and ICIS combined with anti angiogenesis enables some patients with advanced liver cancer to transform unresectable primary liver cancer into resectable primary liver cancer through transformation treatment.Therefore,transforming unresectable liver cancer into resectable liver cancer is the key to improve the therapeutic effect of advanced liver cancer.However,with the increasing number of treatment methods,how to choose the transformation method with the highest transformation efficiency,so as to improve the surgical resection rate,and then improve the survival time and quality of life of patients with liver cancer.The purpose of this study is to systematically evaluate the transformation efficiency of several common transformation treatment methods of unresectable liver cancer through the method of evidence-based medicine,so as to provide evidence-based medicine basis for future scientific research and clinical application.Methods:Search Pub Med,Cochrane Library,EMBASE,CNKI,VIP database,Wanfang database and other Chinese and foreign databases.Use the strategy of full search based on subject words and free words to search the research on the transformation treatment of unresectable liver cancer.At the same time,browse the reference literature directory of relevant reviews and manually search the possible missing research.According to the inclusion criteria and exclusion criteria,the final included literature was determined,and the basic information of the included study was extracted.With the help of Stata 15.0,meta disc 1.4and Revman 5.3 statistical software,the influence of transformation treatment methods of unresectable liver cancer on the transformation effect was meta analyzed.Results:Finally,35 literatures were included,and the total number of patients included in the research literature was 5015,which was shown by the results of meta-analysis.When TACE alone was used in interventional therapy to transform unresectable liver cancer,the ES value of orr was 0.34 and the 95% confidence interval was（0.12,0.60）;The ES value of Cr was 0.03,and the 95% confidence interval was（0,0.08）;The ES value of PR was 0.28 and the 95% confidence interval was（0.09,0.52）.When HAIC alone was used to transform unresectable liver cancer,the ES value of orr was 0.31 and the 95% confidence interval was（0.22,0.42）;The ES value of Cr was 0.06,and the 95%confidence interval was（0.01,0.12）;The ES value of PR was 0.28 and the 95% confidence interval was（0.18,0.35）.The orr of resectable liver cancer was 16.0（95,0.0）;The ES value of Cr was 0.06,and the 95%confidence interval was（0.02,0.13）;The ES value of PR was 0.33 and the 95% confidence interval was（0.8,0.64）.To sum up the data of the three groups,there was no significant difference in orr between TACE group,HAIC group and tare group when using interventional therapy alone（0.34,0.31,0.42）,but in the comparison of Cr,tare group and HAIC group were higher than TACE group（0.06,0.06,0.03）.Overall,the effect of interventional therapy alone in the transformation of unresectable liver cancer is not good.When TKI alone was used to transform unresectable liver cancer in systematic treatment,the ES value of orr was 0.07 and the 95%confidence interval was（0.04,0.10）;The ES value of Cr was 0.01,and the 95% confidence interval was（0.01,0.03）;The ES value of PR was0.06,and the 95% confidence interval was（0.03,0.22）.When TKI combined with PD1 alone was used to transform unresectable liver cancer,the ES value of orr was 0.40,and the 95% confidence interval was（0.32,0.48）;The ES value of Cr was 0.09,and the 95% confidence interval was（0.06,0.13）;The ES value of PR was 0.28 and the 95%confidence interval was（0.22,0.35）.When chemotherapy was used to transform unresectable liver cancer,the ES value of orr was 0.21 and the 95% confidence interval was（0.12,0.31）;The ES value of Cr was0.01,and the 95% confidence interval was（0,0.03）;The ES value of PR was 0.18 and the 95% confidence interval was（0.10,0.29）.To sum up,the three groups of data show that when TKI is used alone for the transformation treatment of unresectable liver cancer,both the ES value of Orr and the ES value of Cr are low,suggesting that the transformation effect is poor.When systemic chemotherapy alone is used for the transformation treatment of unresectable liver cancer,the ES values of various indexes are also low,and the transformation effect is not satisfactory.When TKI combined with PD1 is used for the transformation treatment of unresectable liver cancer,the ES values of Orr and Cr are significantly increased（ORR: 0.06,0.40;Cr: 0.02,0.09）,suggesting that the transformation of unresectable liver cancer by TKI alone should be avoided,Targeted therapy combined with immunotherapy can greatly improve the therapeutic effect.The ES value of orr was 0.42,95% confidence interval was（0.22,0.64）when TKI combined with interventional therapy was used in the combined treatment of unresectable liver cancer;The ES value of Cr was 0.09,and the 95% confidence interval was（0.06,0.12）;The ES value of PR was 0.32 and the 95% confidence interval was（0.12,0.57）.When immunotherapy combined with targeted therapy combined with interventional therapy was used to transform unresectable liver cancer,the ES value of orr was 0.58,95% confidence interval was（0.41,0.74）;The ES value of Cr was 0.28,and the 95% confidence interval was（0.17,0.36）;The ES value of PR was 0.45 and the 95% confidence interval was（0.37,0.53）.The ES values of orr,Cr and PR in immunotherapy combined with targeted therapy combined with interventional therapy were significantly higher than those in other groups.The ES value of Cr was 0.28,the highest in other groups was0.09,the ES value of orr was 0.58,and the highest in other groups was0.42.In conclusion,immunotherapy combined with targeted therapy combined with interventional therapy has the highest transformation efficiency in the transformation treatment of unresectable liver cancer,which can maximize the ability of patients with advanced liver cancer to control their condition and strive to reach the descending stage,so as to carry out surgical treatment.Conclusions:Targeted therapy combined with immunotherapy combined with interventional therapy has the highest Cr,PR and orr in the transformation treatment of unresectable liver cancer,which can control the progress of the disease to the greatest extent,achieve partial remission and complete remission,realize the decline of the tumor,and strive for the opportunity of surgical treatment.The effect of targeted therapy（TKI）alone on the transformation of unresectable liver cancer is poor,and the therapeutic effect can be significantly improved after combined interventional therapy and immunotherapy. |
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