High-Risk Hepatocellular Carcinoma: Hepatic Arterial Infusion Chemotherapy versus Transarterial Chemoembolization

Objective: To compare the efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) with transarterial chemoembolization (TACE) for the treatment of high-risk hepatocellular carcinoma (hHCC) patients.Methods: Between January 2014 and August 2022, a total of 1765 consecutive patients with hHCC who underwent initial intraarterial therapies were reviewed and divided into a TACE group (n, 507) and a HAIC group (n, 426).The study used propensity score matching (PSM) to reduce selectivity bias.Overall survival (OS) and progression-free survival (PFS) were compared using Kaplan-Meier curves with the Log rank test.The objective response rate (ORR), conversion surgery rate (CSR) adverse event (AE) comparison and subgroup analysis were performed between the two groups.Results: After PSM 1:1, 444 patients were divided into two groups.The patients with hHCC who received HAIC had higher median PFS (6.1 vs 3.3 months, P < 0.001) and OS (10.3 vs 8.2 months, P=0.303) than TACE.Higher ORR (24.8% vs 11.7%) and CSR (15.5% vs 8.9%) were found in the HAIC group than in the TACE group (both P < 0.05).The incidence of grade 3/4 AE was 23.9% and 8.1% in the TACE and HAIC groups, respectively.The subgroup analysis suggest that HAIC appeared to particularly benefit patients with tumor diameter of more than 10 centimeters (hazard ratio [HR], 0.6; 95% CI, 0.47-0.77;p, 0.00) and PVTT Vp4 (HR, 0.56; 95% CI, 0.39-0.8;P, 0.01) for PFS outperforming TACE.Conclusion: HAIC can provide better disease control for hHCC than cTACE, with a comparable long-term OS and safety.