Literature search
A total of 90 relevant publications were identified through database search and screened for relevance. After duplicating and reviewing the titles, abstracts and full texts, three articles[20, 28, 29] were eligible for this meta-analysis (Fig.1). Among these studies, one study was RCT and two studies were retrospective.
Study Characteristics
The baseline characteristics of the included publications are summarized in Table 1. Three studies including a total of 214 advanced HCC patients with PVTT included in the final analysis, 111 patients were assigned to HAIC group and 103 to the sorafenib group. Among the three studies, two were performed in Korean, and one was
performed in Japan. Based on the data available for all enrolled studies, the male to female ratio of HAIC and sorafenib group were 92/19 and 83/20, with median age was ranged from 54 years to 68 years. Most patients had Child-Pugh class A liver function in the HAIC (97.7%) and sorafenib group (83.5%), and were Vp3 and Vp4 (portal vein invasion, Vp).
Overall survival (OS)
All studies reported the median OS ranging from 4 to 14.9 months (Table 2). The HR of OS was available in all three studies. After pooling the data, no significant difference was found in the OS between HAIC and sorafenib group (HR=0.77, 95%CI: 0.56-1.06, p=0.11), although the overall meta-analysis revealed that HR was lower for the patients treated with HAIC than sorafenib. There was no heterogeneity was detected (I2= 39%, P= 0.19), so the fixed effect model was adopted (Fig. 2).
Time to progression (TTP)
Three studies provided the data of TTP with a median ranging from 1.2 to 4.4 months (Table 2). The aggregated results suggested that the risk of disease progression in the HAIC group was lower than that in the sorafenib groups (HR = 0.56, 95% CI: 0.39-0.82; P = 0.003) (Fig.3). We adopted the fixed effect model because no significant heterogeneity was found (P = 0.68, I2 = 0%).
Partial response rate (PRR)
All three of selected studies compared the PRR between the HAIC group and Sorafenib group. No significant heterogeneity was observed in the PRR (P = 0.24, I2 = 30%), so a fixed-effects model was used to pooled the data. As shown in Fig.4, the HAIC group was linked with higher PRR than sorafenib group (OR = 3.31, 95% CI: 1.46-7.50; P = 0.004).
Complete response rate (CRR)
All three of selected studies compared the CRR between the HAIC group and Sorafenib group. No significant heterogeneity was observed in the PRR (P = 0.91, I2 = 0%), so a fixed-effects model was used to pooled the data. As shown in Fig.5, no significant difference existed in the CRR when the HAIC compared with the sorafenib group. (OR = 2.54, 95% CI: 0.39-16.47; P = 0.33).
Objective response rate (ORR)
All three of selected studies compared the ORR between the HAIC group and Sorafenib group. No significant heterogeneity was observed in the PRR (P = 0.21, I2 = 35%), so a fixed-effects model was used to pooled the data. As shown in Fig.6, the HAIC group achieved higher ORR when compared with sorafenib group (OR = 3.78, 95% CI: 1.68-8.50; P = 0.001).
Stable disease rate (SDR)
All studies reported the SDR data between HAIC group and sorafenib group. The pooled data showed that no significance difference was found between the two group (OR = 1.48, 95% CI: 0.43-5.08; P = 0.001). Random-model effect was used because high statistical heterogeneity existed (P = 0.02, I2 = 75%).