The effect of age, sex, and eastern cooperative oncology group performance status on the efficacy and safety of immune checkpoint inhibitors in patients with hepatocellular carcinoma: a systematic review and meta-analysis

Abstract

ABSTRACT Background The effect of age, sex, and eastern cooperative oncology group performance status (ECOG PS) on the efficacy and safety of immune checkpoint inhibitor (ICI) therapy among hepatocellular carcinoma (HCC) patients remains elusive. Thus, a meta-analysis was conducted to evaluate whether such effects exist. Research design and methods Eligible studies in PubMed, Embase, and Cochrane Library databases were retrieved. Results One-hundred-and-eleven studies involving 14,768 HCC patients were included. The findings indicated that the ECOG PS didn’t have a significant effect on the ORR and PFS in ICI-treated HCC patients (higher ECOG PS vs. lower ECOG PS: ORR: OR = 0.78, 95%CI = 0.55–1.10; PFS: HR = 1.15, 95%CI = 0.97–1.35), while those patients with a higher ECOG PS may have a worse OS (HR = 1.52, 95% CI = 1.26–1.84). There is no significant evidence of the effect of age (older vs. younger) or sex (males vs. females) on the efficacy of ICI therapy in HCC. Conclusion ICI therapy in HCC should not be restricted strictly to certain patients in age or sex categories, while HCC patients with higher ECOG PS may require closer medication or follow-up strategy during ICI therapy. PROSPERO Registration CRD42024518407