Efficacy of hepatic artery infusion chemotherapy combined with tyrosine kinase inhibitors (TKIs) in advanced hepatocellular carcinoma: a comparison with transarterial chemoembolization combined with TKIs.

BackgroundHepatic artery infusion chemotherapy (HAIC) combined with tyrosine kinase inhibitors (TKIs) shows promise for treating advanced hepatocellular carcinoma (HCC).PurposeTo compare the efficacy and safety of HAIC versus transarterial chemoembolization (TACE), each combined with TKIs, in patients with advanced HCC.Material and MethodsThis retrospective study analyzed 86 patients with unresectable HCC, predominantly Barcelona Clinic Liver Cancer (BCLC) stage B/C and with well-preserved liver function, treated at a tertiary medical center between January 2019 and December 2022. Patients were assigned to either the HAIC + TKI group (n = 40) or the TACE + TKI group (n = 46) based on multidisciplinary team recommendations, considering tumor burden, vascular invasion, and patient preference. Overall survival (OS) was evaluated using Kaplan-Meier analysis, and treatment-related adverse events (AEs) were recorded.ResultsThe median OS was 13.7 months in the HAIC group and 8.3 months in the TACE group (hazard ratio = 0.5489, 95% confidence interval = 0.3557-0.8472;  = 0.00661). The most frequent grade 3/4 AEs were elevated ALT (15.0% vs. 39.1%), elevated AST (17.5% vs. 34.8%), and abdominal pain (25.0% vs. 28.3%), with only ALT showing significant between-group difference. All AEs were manageable, with no treatment-related deaths.ConclusionIn a cohort of patients with unresectable HCC, primarily BCLC stage B/C, and preserved liver function, HAIC combined with TKIs offers superior survival and tumor control compared to TACE + TKIs in unresectable HCC, with acceptable safety. Prospective multicenter trials are needed to validate these findings and further optimize treatment strategies.