Comparison of Hepatic Arterial Infusion Chemotherapy and Transarterial Chemoembolization for Advanced Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis

Aims: To compare the efficacy, safety, and survival outcomes of hepatic arterial infusion chemotherapy (HAIC) versus transarterial chemoembolization (TACE) for the treatment of advanced hepatocellular carcinoma (HCC), a comprehensive meta-analysis was conducted. Methods: MEDLINE, PubMed, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials were searched from January 1966 to 20 February 2022, and relevant articles were retrieved. The literature search, quality assessment, and data extraction were conducted independently by two reviewers. The primary endpoints were objective response rate (ORR) and overall survival (OS), while the secondary endpoints were disease control rate (DCR), progression-free survival (PFS), and adverse events. The odd ratios (OR) and hazard ratios (HR) with 95% confidence intervals (95%CI) were pooled. Results: Seven studies with a total of 989 patients were included in this meta-analysis. The pooled results showed that HAIC significantly improved ORR (OR=4.94, 95%CI: 3.47-7.05, p<0.001) and DCR (OR=2.97, 95%CI: 2.16-4.08, p<0.001). In addition, HCC patients who received HAIC had significantly longer PFS (HR=0.54, 95%CI: 0.45- 0.65, p<0.001) and OS ( HR=0.55, 95%CI: 0.46-0.66, p<0.001) than those who underwent TACE. Compared with TACE, HAIC showed a lower incidence for grade 3-4 adverse events (OR=0.52, 95%CI: 0.30-0.88, p<0.001). Conclusions: HAIC may significantly improve survival benefits and exhibit higher local treatment responses with mild side effects in patients with advanced HCC compared to TACE.