Efficacy of hepatic arterial infusion chemotherapy in advanced hepatocellular carcinoma: survival outcomes and prognostic factors from a systematic review and meta-analysis.
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BACKGROUND: Advanced hepatocellular carcinoma (HCC) poses significant treatment challenges, with limited options and poor prognosis. Hepatic arterial infusion chemotherapy (HAIC) has emerged as a promising therapy, potentially offering superior outcomes compared to transarterial chemoembolization (TACE). This study aimed to systematically compare the survival outcomes and safety profiles of HAIC versus TACE in patients with advanced HCC, and to identify key prognostic factors influencing treatment efficacy to guide personalized therapeutic strategies. METHODS: This meta-analysis included 14 studies assessing survival outcomes and safety profiles of HAIC versus TACE in advanced HCC. Overall survival (OS), progression-free survival (PFS), and adverse events were analyzed. Subgroup analyses evaluated the influence of prognostic factors such as tumor size, alpha-fetoprotein (AFP) levels, and vascular invasion. RESULTS: HAIC significantly improved OS [hazard ratio (HR) =0.51] and PFS (HR =0.55) compared to TACE in advanced HCC. Subgroup analyses identified multiple prognostic factors favoring HAIC for better outcomes. For OS, HAIC showed significant benefits in subgroups including male gender (HR =0.57), AFP <400 ng/mL (HR =0.59), tumor number ≥3/5 (HR =0.75), hepatitis B virus (HBV)-positive patients (HR =0.50), vascular invasion (HR =0.50), extrahepatic metastasis (HR =0.55), and portal vein tumor thrombus (PVTT) presence (HR =0.34). For PFS, HAIC demonstrated superior outcomes in patients aged >60 years (HR =0.67), Eastern Cooperative Oncology Group (ECOG) ≥1 (HR =0.65), AFP ≥400 ng/mL (HR =0.48), tumor size ≥10 cm (HR =0.54), Child-Pugh A (HR =0.63), vascular invasion (HR =0.49), extrahepatic metastasis absence (HR =0.57), and Barcelona Clinic Liver Cancer (BCLC) Stage C (HR =0.64). CONCLUSIONS: HAIC offers significant survival benefits (OS and PFS) and a favorable safety profile compared to TACE in advanced HCC. These findings highlight HAIC as a valuable treatment option, particularly for patients with poor prognostic factors, and emphasize the need for personalized therapeutic strategies to optimize outcomes.