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. 2023 May 1;109(5):1222-1230.
doi: 10.1097/JS9.0000000000000256.

TACE-HAIC combined with targeted therapy and immunotherapy versus TACE alone for hepatocellular carcinoma with portal vein tumour thrombus: a propensity score matching study

Yichuan Yuan  1   2 , Wei He  1   2 , Zhiwen Yang  1   2 , Jiliang Qiu  1   2 , Zhenkun Huang  1   2 , Yunxing Shi  1   2 , Zhu Lin  1   2 , Yun Zheng  1   2 , Minshan Chen  1   2 , Wan Yee Lau  3 , Binkui Li  1   2 , Yunfei Yuan  1   2
Affiliations

TACE-HAIC combined with targeted therapy and immunotherapy versus TACE alone for hepatocellular carcinoma with portal vein tumour thrombus: a propensity score matching study

Yichuan Yuan et al. Int J Surg. .

Abstract

Background: The long-term survival of patients with hepatocellular carcinoma (HCC) with portal vein tumour thrombus (PVTT) is poor. Systemic therapy, transcatheter arterial chemoembolization (TACE), and hepatic artery infusion chemotherapy are widely used in HCC patients with PVTT. This study aims to explore the efficacy of combining systemic therapy with transarterial-based therapy in HCC patients with PVTT.

Materials and methods: The authors retrospectively reviewed data of HCC patients with PVTT treated with combination therapy (TACE-hepatic artery infusion chemotherapy with tyrosine kinase inhibitors and PD-1 inhibitors) or TACE alone in SYSUCC from 2011 to 2020. The overall survival (OS), progression-free survival, and overall response rate were compared. Propensity score matching was used to minimize confounding bias.

Results: A total of 743 HCC patients with PVTT received combination therapy ( n =139) or TACE alone ( n =604). After propensity score matching, the overall response rate was significantly higher in the combination group than in the TACE group [42.1% vs. 5.0%, P < 0.001 (response evaluation criteria in solid tumours); 53.7% vs. 7.8%, P < 0.001 (modified response evaluation criteria in solid tumours)]. The combination group showed significantly better OS than the TACE group (median OS not reached vs. 10.4 months, P < 0.001). The median progression-free survival of the combination and TACE groups was 14.8 and 2.3 months ( P < 0.001), respectively. Tumour downstaging followed by salvage liver resection was significantly more common for the combination therapy group than for TACE group (46.3% vs. 4.5%, P < 0.001). After salvage liver resection, 31.6% (30/95) and 1.7% (3/179) of the patients achieved a pathological complete response in the combination and TACE groups, respectively ( P < 0.001). The grade 3/4 adverse events rates were similar between the two groups (28.1% vs. 35.9%, P =0.092).

Conclusion: Compared with TACE alone, combination therapy was safe enough and resulted in survival benefits. This is a promising treatment option for HCC patients with PVTT.

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Conflict of interest statement

The authors declare that they have no competing interests.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
Flow diagram of HCC patients with PVTT who underwent combination therapy or TACE. ECOG, Eastern Cooperative Oncology Group; HCC, hepatocellular carcinoma; PSM, propensity score matching; PVTT, portal vein tumour thrombus; TACE, transcatheter arterial chemoembolization.
Figure 2
Figure 2
Histogram depicting response of PVTT using the RECIST criteria in the combination therapy and TACE groups after PSM. PSM, propensity score matching; PVTT, portal vein tumour thrombus; RECIST, response evaluation criteria in solid tumours TACE, transcatheter arterial chemoembolization.
Figure 3
Figure 3
Kaplan–Meier survival curves comparing OS and PFS among patients who underwent combination therapy versus TACE before (A–B) and after PSM (C, D). The combination therapy group had significantly longer OS and better PFS than the TACE group (all P < 0.001). OS, overall survival; PFS, progression-free survival; PSM, propensity score matching; TACE, transcatheter arterial chemoembolization.
See this image and copyright information in PMC

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