OBJECTIVE To systematically evaluate the efficacy and safety of transcatheter arterial chemoembolization(TACE)combined with anti-angiogenic drugs for the treatment of unresectable primary liver cancer(PLC).METHODS Retrieved from Chinese and English databases such as CNKI,the Cochrane Library,Google,and Baidu Academic,randomized controlled trial(RCT)about TACE combined with anti-angiogenic drugs for the treatment of unresectable PLC were collected from the inception to May 27,2024.After screening the literature,extracting data,and evaluating the quality of the literature,network meta-analysis was performed using R 4.2.2 and Stata 17.0.RESULTS A total of 44 RCT were included,involving 5 607 patients and 8 interventions.The network meta-analysis results showed that for prolonging median overall survival(mOS)and median progression-free survival(mPFS),TACE+apatinib had the best efficacy,with TACE+apatinib and TACE+sorafenib ranking as the top two.For improving objective response rate(ORR)and disease control rate(DCR),TACE+donafenib had the best efficacy,with TACE+donafenib and TACE+lenvatinib ranking as the top two.In terms of safety,TACE+donafenib was the best,with TACE+donafenib and TACE+apatinib ranking as the top two.CONCLUSIONS TACE+apatinib and TACE+donafenib have good efficacy for patients with unresectable PLC,and TACE+donafenib has the best safety profile.
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