{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T06:04:47Z","timestamp":1780639487760,"version":"3.54.1"},"reference-count":53,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The therapeutic landscape of advanced hepatocellular carcinoma (HCC) has expanded beyond sorafenib, with multiple combination regimens now demonstrating improved outcomes. However, the absence of direct head-to-head comparisons complicates treatment selection in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a Bayesian network meta-analysis of phase III randomized controlled trials to compare the efficacy and safety of first-line treatments for patients with advanced HCC. Overall survival (OS), progression-free survival (PFS), and grade \u2265 3 adverse events were assessed. Treatment rankings were estimated using surface under the cumulative ranking curve values.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sixteen trials comprising 8, 753 patients were included. Hepatic arterial infusion chemotherapy (HAIC)-based regimens, particularly sorafenib plus HAIC and HAIC_FO, achieved the highest rankings for both PFS and OS. Several immunotherapy-based combinations also demonstrated significant survival benefits across multiple clinical subgroups without a corresponding increase in severe adverse events. Subgroup analyses suggested consistent benefits of selected regimens across age, sex, macrovascular invasion, extrahepatic spread, and ECOG performance status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>HAIC-based strategies and selected immunotherapy combinations appear to provide superior survival outcomes as first-line treatment for advanced HCC. Given limitations related to comparator selection and evolving evidence, future head-to-head randomized trials and updated network analyses are warranted to refine optimal treatment strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Systematic review registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.crd.york.ac.uk\/prospero\/<\/jats:ext-link>\n                      , identifier CRD420251124082.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1846603","type":"journal-article","created":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T05:40:30Z","timestamp":1780638030000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparative efficacy and safety of first-line treatments for advanced hepatocellular carcinoma: a Bayesian network 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China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiuju","family":"Huang","sequence":"additional","affiliation":[{"name":"Key Laboratory of Longevity and Aging-related Diseases of Chinese Ministry of Education & Guangxi Key Laboratory of Bioactive Molecules Research and Evaluation, Pharmaceutical College, Guangxi Medical University","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chun","family":"Yao","sequence":"additional","affiliation":[{"name":"Guangxi University of Chinese Medicine","place":["Nanning, China"]},{"name":"Guangxi Universities Engineering Research Center for Innovative Product Development of Regional Priority Diseases","place":["Nanning, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Fu","sequence":"additional","affiliation":[{"name":"Guangxi University of Chinese Medicine","place":["Nanning, China"]},{"name":"Guangxi Universities Engineering Research Center for 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