随着肝细胞癌（HCC）系统治疗的快速进展，肝动脉灌注化疗（HAIC）与系统治疗相结合的治疗策略日益集中。然而，目前尚无比较HAIC及其联合治疗方案在晚期HCC一线治疗中的系统评价。为了研究HAIC及其联合治疗方案对晚期HCC的疗效和安全性，我们进行了网络荟萃分析，纳入了9项研究。我们的研究通过随机对照试验和 35 项队列研究进行。感兴趣的结果包括总生存期（OS）、无进展生存期（PFS）、肿瘤反应和不良事件。计算具有 95% 置信区间 (CI) 的风险比 (HR) 和比值比 (OR)，并根据其排名概率对药物进行排名。HAIC 优于索拉非尼（HR = 0.55，95% CI：0.42-0.72；HR = 0.51，95%CI：0.33-0.78；OR = 2.86，95%CI：1.37-5.98；OR = 5.45，95%CI：3.57-8.30；OR = 7.15，95%CI：4.06-12.58； 95%CI：1.99-4.19；OR = 0.48，95%CI：0.25-0.92）和经动脉化疗栓塞术 (TACE)（HR = 0.50，95%CI：0.33-0.75；HR = 0.62，95%CI：0.39 -0.98；OR = 3.08，95% CI：1.36-6.98；OR = 2.07，95% CI：1.54-2.80；OR = 3.16，95% CI：1.71-5.85；OR = 2.67，95% CI：1.59-4.50 ；就有效性和安全性而言，OR = 0.16，95%CI：0.05-0.54。与单独使用 HAIC 相比，HAIC 仑伐替尼消融、HAIC 消融、HAIC 抗程序性细胞死亡 1 (PD-1) 和 HAIC 放疗更有可能提供更好的 OS 和 PFS 结果。与 HAIC 相比，HAIC TACE S-1、HAIC 仑伐替尼、HAIC PD-1、HAIC TACE 和 HAIC 索拉非尼更有可能提供更好的部分缓解和客观缓解率结果。与单独使用 HAIC 相比，HAIC PD-1、HAIC TACE S-1 和 HAIC TACE 更有可能提供更好的完全缓解和疾病控制率结果。事实证明，HAIC 比索拉非尼和 TACE 更有效、更安全。此外，根据治疗排名分析，与其他干预措施相结合，HAIC 的疗效优于 HAIC 单一疗法。©作者 2024。百事登出版集团有限公司出版。保留所有权利。

With the rapid progress of systematic therapy for hepatocellular carcinoma (HCC), therapeutic strategies combining hepatic arterial infusion chemotherapy (HAIC) with systematic therapy arised increasing concentrations. However, there have been no systematic review comparing HAIC and its combination strategies in the first-line treatment for advanced HCC.To investigate the efficacy and safety of HAIC and its combination therapies for advanced HCC.A network meta-analysis was performed by including 9 randomized controlled trails and 35 cohort studies to carry out our study. The outcomes of interest comprised overall survival (OS), progression-free survival (PFS), tumor response and adverse events. Hazard ratios (HR) and odds ratios (OR) with a 95% confidence interval (CI) were calculated and agents were ranked based on their ranking probability.HAIC outperformed Sorafenib (HR = 0.55, 95%CI: 0.42-0.72; HR = 0.51, 95%CI: 0.33-0.78; OR = 2.86, 95%CI: 1.37-5.98; OR = 5.45, 95%CI: 3.57-8.30; OR = 7.15, 95%CI: 4.06-12.58; OR = 2.89, 95%CI: 1.99-4.19; OR = 0.48, 95%CI: 0.25-0.92, respectively) and transarterial chemoembolization (TACE) (HR = 0.50, 95%CI: 0.33-0.75; HR = 0.62, 95%CI: 0.39-0.98; OR = 3.08, 95%CI: 1.36-6.98; OR = 2.07, 95%CI: 1.54-2.80; OR = 3.16, 95%CI: 1.71-5.85; OR = 2.67, 95%CI: 1.59-4.50; OR = 0.16, 95%CI: 0.05-0.54, respectively) in terms of efficacy and safety. HAIC + lenvatinib + ablation, HAIC + ablation, HAIC + anti- programmed cell death 1 (PD-1), and HAIC + radiotherapy had the higher likelihood of providing better OS and PFS outcomes compared to HAIC alone. HAIC + TACE + S-1, HAIC + lenvatinib, HAIC + PD-1, HAIC + TACE, and HAIC + sorafenib had the higher likelihood of providing better partial response and objective response rate outcomes compared to HAIC. HAIC + PD-1, HAIC + TACE + S-1 and HAIC + TACE had the higher likelihood of providing better complete response and disease control rate outcomes compared to HAIC alone.HAIC proved more effective and safer than sorafenib and TACE. Furthermore, combined with other interventions, HAIC showed improved efficacy over HAIC monotherapy according to the treatment ranking analysis.©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.