LAUSR

BACKGROUND The prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is very poor. This study aimed to evaluate hepatic arterial infusion chemotherapy (HAIC) versus sorafenib (SORF) in the treatment of HCC with PVTT. METHODS Studies were identified online in Embase and MEDLINE before October 31, 2019. The endpoints were overall survival (OS), progression-free survival (PFS), disease control rate (DCR), and safety. RESULTS Six studies with 417 cases were included in this systematic review. Meta-analyses demonstrated that HAIC is superior to SORF with respect to OS (hazard ratio (HR): 0.50, 95%CI: 0.38-0.66, P < 0.001) and DFS (HR: 0.47, 95%CI: 0.31-0.73, P = 0.001) irrespective of research territoriality and study quality. Our systematic review also demonstrated that HAIC is superior to SORF with respect to DCR. Subgroup analysis demonstrated that the advantage is more obvious in the treatment of type III-IV PVTT with respect to OS (HR: 0.29, P < 0.001) and PFS (HR: 0.39, P < 0.001). HAIC caused more grade 3-4 neutropenia (HR: 10.71), anemia (HR: 7.55), leukopenia (HR: 10.38), and thrombocytopenia (HR: 13.09) than SORF. However, HAIC caused fewer cases of grade 3-4 AST rising (HR: 0.21), diarrhea (HR: 0.14), and hand-foot syndrome (HR: 0.14) than SORF. CONCLUSIONS This systematic review demonstrated that HAIC is superior to SORF in HCC with PVTT with respect to OS, DFS, and DCR, especially in HCC with type III-IV PVTT. HAIC caused more myelosuppression, whereas SORF is associated with diarrhea and hand-foot syndrome. Further randomized controlled trials are warranted.