免疫检查点抑制剂（ICIs）已被证明对晚期肝细胞癌（HCC）有效。然而，ICIs 在不同病因的 HCC 患者中的疗效差异尚未得到系统验证。 检索了 PubMed、MEDLINE、Embase、clinicalTrials.gov 以及 ASCO 和 ESMO 会议摘要，寻找探讨病因因素影响的合格试验HCC 患者的 ICI 治疗。通过乙型肝炎病毒（HBV）分层计算总生存期（OS）和无进展生存期（PFS）的汇总风险比（HR）以及客观缓解率（ORR）的汇总比值比（OR） ）、丙型肝炎病毒（HCV）和非病毒亚组，并通过交互检验评估不同病因亚组之间的异质性。通过检索已发表的文章和会议摘要，确定了八项符合条件的研究，共涉及 5,646 名患者。 ICI 治疗与 OS 显着延长相关，汇总 HR 分别为 0.78 (95% CI 0.73-0.84，p < 0.001)、0.71 (95% CI 0.65-0.79，p < 0.001)、0.80 (95% CI 0.69-0.93，对于整个人群、HBV 亚组、HCV 亚组和非病毒亚组，该值分别为 0.87（95% CI 0.77-0.97，p = 0.011）。此外，该分析报告显示，ICI 疗法显着改善了 PFS，整个人群、HBV、分别为 HCV 和非病毒亚组。与其他病因亚组相比，HBV 相关 HCC 患者的 OS 和 PFS 的 HR 更显着，其中 PFS 差异显着（异质性 p = 0.001），OS 存在显着性趋势（异质性 p = 0.079） ）。此外，ICI 疗法相对于对照的 ORR 优势也得到了证实，整个人群的汇总 OR 分别为 3.62 (p < 0.001)、3.84 (p < 0.001)、3.05 (p < 0.001) 和 2.99 (p < 0.001)。分别为 HBV、HCV 和非病毒人群（异质性 p = 0.743）。ICI 疗法可显着改善不同病因 HCC 患者的 OS、PFS 和 ORR。 HBV 相关 HCC 患者可能是受益于 ICI 治疗的重点人群。© 2023 作者。由巴塞尔 S. Karger AG 出版。

Immune checkpoint inhibitors (ICIs) have demonstrated effectiveness for advanced hepatocellular carcinoma (HCC). However, the discrepancy in the efficacy of ICIs in HCC patients with distinct etiologies has not been systematically validated.PubMed, MEDLINE, Embase, clinicaltrials.gov, and abstracts from ASCO and ESMO conferences were searched for eligible trials that explored the impact of etiology factor on the ICI treatment in HCC patients. The pooled hazard ratio (HR) of overall survival (OS) and progression-free survival (PFS), as well as the pooled odds ratio (OR) of objective response rate (ORR), were calculated with stratification of hepatitis B virus (HBV), hepatitis C virus (HCV) and nonviral subgroup, and the heterogeneity between different etiological subgroups was assessed by using an interaction test.Eight eligible studies with a total of 5,646 patients were identified from searching published articles and conference abstracts. ICI therapies were associated with significantly prolonged OS with the pooled HRs of 0.78 (95% CI 0.73-0.84, p < 0.001), 0.71 (95% CI 0.65-0.79, p < 0.001), 0.80 (95% CI 0.69-0.93, p = 0.003), and 0.87 (95% CI 0.77-0.97, p = 0.011) for the whole population, HBV subgroup, HCV subgroup, and non-viral subgroup, respectively. In addition, this analysis reported a significant PFS improvement with ICI therapies with HRs of 0.78 (p = 0.004), 0.53 (p < 0.001), 0.65 (p = 0.011), and 0.81 (p = 0.107) for whole population, HBV, HCV, and nonviral subgroup, respectively. The HBV-related HCC patients showed the more distinctive HRs for OS and PFS than other etiology subgroups, and this difference was significant in PFS (p for heterogeneity = 0.001), and there was a tendency of significance in OS (p for heterogeneity = 0.079). Furthermore, the ORR advantages of ICI therapies over control were also confirmed with the pooled ORs of 3.62 (p < 0.001), 3.84 (p < 0.001), 3.05 (p < 0.001), and 2.99 (p < 0.001) for whole population, HBV, HCV, and nonviral population, respectively (p for heterogeneity = 0.743).ICI therapies significantly improve OS, PFS, and ORR for HCC patients with different etiologies. HBV-related HCC patients could be the highlighted population to benefit from ICI treatment.© 2023 The Author(s). Published by S. Karger AG, Basel.