Objective: To compare the clinical efficacy and safety of transcatheter hepatic arterial infusion chemotherapy (HAIC) with those of sorafenib in the treatment of patients with hepatocellular carcinoma (HCC) of Barcelona Clinic Liver Cancer (BCLC) stage C.
Methods: Potentially relevant studies comparing the clinical efficacy and safety of HAIC with those of sorafenib were searched using Medline, PubMed, Embase, Cochrane Library, and Chinese databases (Wanfang Data and China National Knowledge Infrastructure). Overall survival rate (OSR), tumor response rate, disease control rate (DCR), and serious adverse events (SAEs) were compared and analyzed. Pooled ORs with 95% CIs were calculated using either the fixed-effects model or the random-effects model. All statistical analyses were conducted using Review Manager (version 5.3) from the Cochrane Collaboration.
Results: A total of 1,264 patients were included in this meta-analysis. The results of this study showed that HAIC was associated with significantly higher 1-, 2-, and 3-year OSRs than sorafenib (OR 1.88, 95% CI_1-year: [1.27–2.78], P _1-year=0.002; OR 2.15, 95% CI_2-year: [1.06–4.37], P _2-year=0.03; OR 7.90, 95% CI_3-year: [2.12–29.42], P _3-year=0.002). Compared to sorafenib, HAIC was associated with superior complete response (CR), partial response (PR), and objective response rate (ORR) (OR 3.90, 95% CI_CR: [1.89–8.03], P _CR =0.0002; OR 3.47, 95% CI_PR: [2.31–5.24], P _PR <0.00001; OR 3.02, 95% CI_OR: [2.05–4.45], P _OR <0.0001). There was no statistically significant difference between HAIC and sorafenib in stable disease (SD), progressive disease (PD), DCR, and SAEs (OR 0.86, 95% CI_SD: [0.51–1.45], P _SD =0.56; OR 0.62, 95% CI_PD: [0.35–1.11], P _PD =0.11; OR 0.53, 95% CIS_AE: [0.14–1.92], P _SAE =0.33).
Conclusion: This study showed that HAIC was associated with better efficacy than sorafenib in terms of OSR and tumor response. Therefore, HAIC can be considered as an alternative treatment option for patients with HCCs of BCLC stage C.
Keywords: HCC, HAIC, targeted therapy, BCLC, prognosis, meta-analysis