Hepatic arterial infusion chemotherapy (HAlC) versus sorafenib for hepatocellular carcinoma (HCC) in Barcelona Clinic Liver Cancer (BCLC) B/C: A systematic review and meta-analysis

Introduction and objectives: Despite both hepatic arterial infusion chemotherapy (HAIC) and sorafenib being efficacious for hepatocellular carcinoma (HCC), choosing between them for Barcelona Clinic Liver Cancer (BCLC) stages B/C patients remains controversial. This meta-analysis aims to compare their therapeutic outcomes and prognoses in such patients. Methods: Pubmed, EMBASE, and Web of Science databases were searched. The primary outcome of this meta-analysis is Overall Survival (OS), while secondary outcomes include Progression-Free Survival (PFS), tumor response rate, and the incidence of adverse events. The analysis has included a total of 18 studies, comprising 3008 patients in aggregate. Results: The analysis revealed a combined Hazard Ratio (HR) for OS of 0.57 (95% CI 0.38–0.86) and for PFS of 0.46 (95% CI 0.38–0.57). Subgroup analysis by different HAIC regimens: FOLFOX-based HAIC regimens 0.28 (95% CI: 0.16–0.50), FP regimen 0.68 (95% CI: 0.25–1.87), New-FP regimen 0.60 (95% CI: 0.47–0.77), cisplatin-based HAIC 0.63 (95% CI: 0.47–0.85). The pooled ORs were: Complete Response (CR) 3.88 (95% CI 1.56–9.65), Partial Response (PR)4.72(95% CI 2.44–9.13), Stable Disease (SD) 0.83 (95% CI 0.45–1.53), Progressive Disease (PD) 0.35 (95% CI0.25–0.48, Objective Response Rate (ORR) 5.32 (95% CI 2.54–11.13), Disease Control Rate (DCR) 2.03 (95% CI 1.05–3.92). For adverse events (AEs), the overall incidence Odds Ratios (OR) was 0.53 (95% CI 0.06–4.82) and for grade 3−4 events, 0.49 (95% CI 0.28–0.85). Conclusions: In Asian and African patients with BCLC stage B/C hepatocellular carcinoma, HAIC—particularly the FOLFOX regimen—confers superior overall survival and oncologic outcomes compared to sorafenib, with higher response and disease control rates and reduced disease progression.