Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jan 27, 2024; 16(1): 91-102
Published online Jan 27, 2024. doi: 10.4254/wjh.v16.i1.91
Sorafenib plus transarterial chemoembolization vs sorafenib alone for patients with advanced hepatocellular carcinoma: A systematic review and meta-analysis
Hong-Jie Yang, Bin Ye, Jia-Xu Liao, Lei Lei, Kai Chen
Hong-Jie Yang, Jia-Xu Liao, Department of Radiology, The Sixth People's Hospital of Chengdu, Chengdu 610000, Sichuan Province, China
Bin Ye, Lei Lei, Department of Oncology, The Sixth People's Hospital of Chengdu, Chengdu 610000, Sichuan Province, China
Kai Chen, Department of Pharmacy, The Affiliated Taizhou People's Hospital of Nanjing Medical University, Taizhou 225300, Jiangsu Province, China
Co-first authors: Hong-Jie Yang and Bin Ye.
Author contributions: Yang HJ and Ye B were responsible for data acquisition, analysis, and interpretation and drafted the article; Liao JX and Lei L were responsible for data analysis and interpretation and revised the article; Chen K was responsible for conception and design of the study and critical revision of the article; all authors issued final approval for the version to be submitted. Yang HJ and Ye B contributed equally to this work as co-first authors. The reasons for designating Yang HJ and Ye B as co-first authors are threefold. First, the research was performed as a collaborative effort, and the designation of co-first authorship accurately reflects the distribution of responsibilities and burdens associated with the time and effort required to complete the study. Second, the overall research team encompassed authors with a variety of expertise and skills from different fields, and the designation of co-first authors best reflects this diversity. Third, Yang HJ and Ye B contributed efforts of equal substance throughout the research process. In summary, we believe that designating Yang HJ and Ye B as co-first authors is fitting for our manuscript as it accurately reflects our team's collaborative spirit, equal contributions, and diversity.
Supported by Sichuan Science and Technology Project, No. 2021YJ0138; Research Subject of Sichuan Provincial Health Commission, No. 19PJ007; Chengdu Science and Technology Project, No. 2021-YF05-01788-SN.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Kai Chen, Pharmacist, Department of Pharmacy, The Affiliated Taizhou People's Hospital of Nanjing Medical University, No. 366 Taihu Road, Taizhou 225300, Jiangsu Province, China.
Received: October 20, 2023
Peer-review started: October 20, 2023
First decision: November 16, 2023
Revised: November 21, 2023
Accepted: December 12, 2023
Article in press: December 12, 2023
Published online: January 27, 2024

Although the past decade has seen remarkable advances in treatment options for hepatocellular carcinoma (HCC), the dismal overall prognosis still envelops HCC patients. Several comparative trials have been conducted to study whether transarterial chemoembolization (TACE) could improve clinical outcomes in patients receiving sorafenib for advanced HCC; however, the findings have been inconsistent.


To study the potential synergies and safety of sorafenib plus TACE vs sorafenib alone for treating advanced HCC, by performing a systematic review and meta-analysis.


This study was conducted following the PRISMA statement. A systematic literature search was conducted using the Cochrane Library, Embase, PubMed, and Web of Science databases. Data included in the present work were collected from patients diagnosed with advanced HCC receiving sorafenib plus TACE or sorafenib alone. Data synthesis and meta-analysis were conducted using Review Manager software.


The present study included 2780 patients from five comparative clinical trials (1 was randomized control trial and 4 were retrospective studies). It was found that patients receiving sorafenib plus TACE had better prognoses in terms of overall survival (OS), with a combined hazard ratio (HR) of 0.65 [95% confidence interval (95%CI): 0.46–0.93, P = 0.02, n = 2780]. Consistently, progression free survival (PFS) and time to progression (TTP) differed significantly between the sorafenib plus TACE arm and sorafenib arm (PFS: HR = 0.62, 95%CI: 0.40–0.96, P = 0.03, n = 443; TTP: HR = 0.73, 95%CI: 0.64-0.83, P < 0.00001, n = 2451). Disease control rate (DCR) was also significantly increased by combination therapy (risk ratio = 1.36, 95%CI: 1.02-1.81, P = 0.04, n = 641). Regarding safety, the incidence of any adverse event (AE) was increased due to the addition of TACE; however, no significant difference was found in grade ≥ 3 AEs.


The combination of sorafenib with TACE has superior efficacy to sorafenib monotherapy, as evidenced by prolonged OS, PFS, and TTP, as well as increased DCR. Additional high-quality trials are essential to further validate the clinical benefit of this combination in the treatment of advanced HCC.

Keywords: Hepatocellular carcinoma, Sorafenib, Transarterial chemoembolization, Systematic review, Meta-analysis

Core Tip: No consensus is available in the literature about whether addition of transarterial chemoembolization (TACE) could improve survival in patients receiving sorafenib for advanced hepatocellular carcinoma. This is the first systematic review and meta-analysis comparing sorafenib/TACE combination therapy and sorafenib monotherapy for advanced hepatocellular carcinoma. We investigated these two treatments in terms of overall survival, progression free survival, time to progression, disease control rate, and adverse events.