Transarterial chemoembolization versus hepatic arterial infusion chemotherapy as first treatment for hepatocellular carcinoma with macrovascular invasion.

Transarterial chemoembolization (TACE) is an optional treatment for hepatocellular carcinoma (HCC) patients with macrovascular invasion (MVI) and without extrahepatic metastasis (EHM). As a recently emerging approach, the efficacy of hepatic arterial infusion chemotherapy (HAIC) compared with TACE in this group of patients is unclear. Between December 2016 and June 2020, patients diagnosed with HCC with MVI and without EHM who underwent TACE (n=91) or HAIC (n=190) as their initial treatment were included. Propensity score matching (PSM) was used to reduce selection bias and other imbalances. The objective response rate (ORR), overall survival (OS), progression-free survival (PFS), rate of subsequent resection, and safety were compared between groups. Seventy-seven pairs of patients were matched after PSM. The ORR was higher in the HAIC group than that in the TACE group (29.9% vs. 9.1%, = 0.013). The median PFS of patients in the HAIC group was longer than that of the patients in the TACE group (4.7 vs. 1.4 months, = 0.002), but there was no significant difference in the median OS between the groups (19.6 vs. 18.1 months, = 0.122). HAIC also showed a better safety profile than TACE. HAIC is an effective and safe option for treating HCC patients with MVI and without EHM compared to TACE.