我们的目标是确定对于晚期肝细胞癌（HCC），包括系统治疗和非局部治疗的最佳治疗选项。感兴趣的结果包括总生存期（OS）、无进展生存期（PFS）、客观反应率（ORR）、3-4级与治疗相关的不良事件（TRAEs）和由于不良事件的治疗中止的发生率。累积排序曲线下的面积概率值（SUCRA）应用于对干预措施进行排名。共纳入了23项随机对照试验，包括14,303名晚期HCC患者。Lenvatinib加经导管行动脉化疗栓塞（TACE）在提供OS方面排名最佳（SUCRA：0.99）。免疫肿瘤学（IO）多激酶抑制剂（MKI） /血管内皮生长因子（VEGF）抑制剂联合疗法具有较高的提供更好OS概率比IO-IO联合疗法。IO单药疗法表现出卓越的安全性，而联合疗法通常会导致更多的毒性。我们得出结论，联合疗法在晚期HCC患者中实现了显著的疗效，临床决策需要仔细平衡疗效与风险。 版权所有©2023 Elsevier B.V.。保留所有权利。

We aim to identify the optimal treatment option of systematic therapy with or without locoregional therapy for advanced hepatocellular carcinoma (HCC). Outcomes of interest include overall survival (OS), progression-free survival (PFS), objective response rate (ORR), grade 3-4 treatment-related adverse events (TRAEs), and incidence of treatment discontinuation due to AEs. The surface under the cumulative ranking curve (SUCRA) probability values were applied to rank the interventions. 23 randomized-controlled trials including 14,303 patients with advanced HCC were included. Lenvatinib plus transcatheter arterial chemoembolization (TACE) ranked best regarding OS benefit (SUCRA: 0.99). Immuno-oncology (IO)-multikinase inhibitor (MKI)/vascular endothelial growth factor (VEGF) inhibitor combinations had a higher probability of providing better OS than IO-IO combinations. IO monotherapies demonstrated superior safety profile while combination therapies caused more toxicity in general. We conclude that combination therapies achieve remarkable efficacy in patients with advanced HCC and clinical decision making requires a careful balance of efficacy versus risk.Copyright © 2023 Elsevier B.V. All rights reserved.