Hepatic arterial infusion chemotherapy versus Sorafenib for advanced hepatocellular carcinoma with portal vein tumor thrombus: a systematic review and meta-analysis

Abstract

Background : Hepatocellular carcinoma (HCC) is ranked as the sixth most common solid cancer and the third leading cause of cancer-related death in the world. Sorafenib is the first line systematic treatment for patients with advanced HCC. Hepatic arterial infusion chemotherapy（HAIC）has been proved to be an effective treatment for advanced HCC. Here, we conducted a meta-analysis to compared the efficacy of HAIC versus sorafenib of advanced HCC patients with PVTT. Methods : The databases of MEDLINE (PubMed), Cochrane Library, EMBASE, and Web of Science were systematically searched for retrieving the relevant publications before 31 July 2019. The endpoint included overall survival (OS), time to progression (TTP), partial response rate (PRR), complete response rate (CRR), objective response rate (ORR), stable disease rate (SDR). Results : A total of three studies involving 214 advanced HCC patients with PVTT enrolled in this meta-analysis. HAIC significantly improved TTP (hazard ratio (HR) = 0.56, 95% CI: 0.39-0.82; P = 0.003), PRR (odds ratio (OR) = 3.31, 95% CI: 1.46-7.50; P = 0.004), ORR (OR = 3.78, 95% CI: 1.68-8.50; P = 0.001) compared to sorafenib. However, no significant difference was found in OS (HR=0.77, 95%CI: 0.56-1.06, p=0.11), CRR (OR = 2.54, 95% CI: 0.39-16.47; P = 0.33), SDR (OR = 1.48, 95% CI: 0.43-5.08; P = 0.001). Conclusions : This meta-analysis suggested that HAIC provides better TTP, PRR, ORR than sorafenib for patients of advanced HCC with PVTT. Therefore, we recommend HAIC as a potential therapy for advanced HCC patients with PVTT. However, owing to the above limitations, more high-quality studies are warranted to evaluate this finding.