Efficacy and safety of transcatheter arterial chemoembolization plus hepatic arterial infusion chemotherapy in the treatment of advanced hepatocellular carcinoma with portal vein tumor thrombosis in the main trunk

Background: Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the sixth most prevalent malignancy worldwide. The incidence of portal vein tumor thrombosis (PVTT) is recorded as high as 10%-60% in HCC patients. The purpose of this study was to assess the efficacy and safety of transcatheter arterial chemoembolization (TACE) plus hepatic arterial infusion chemotherapy (HAIC) in advanced HCC patients complicated with PVTT in the main trunk.

Patients and methods: A total of 33 HCC patients were treated with TACE + HAIC or TACE, respectively. The primary endpoint was overall survival (OS), while the secondary endpoints included progression-free survival, objective response rate (ORR), and disease control rate (DCR) of HCC lesions and PVTT in the trunk. Adverse events and main complications were also investigated. A COX model was used to identify the risk factors associated with OS.

Results: There were 16 patients receiving TACE + HAIC and 17 receiving TACE. The median OS was longer in the TACE + HAIC group than the TACE group (P < 0.05). There were no significant differences in the ORR and DCR of HCC lesions and PVTT response between the two groups (P > 0.05). Alpha-fetoprotein was <400 ng/ml. Multivariate analysis showed that cavernous transformation of portal vein was associated with longer OS. In terms of complications, the addition of HAIC showed more myelosuppression than the TACE alone group (P < 0.05).

Conclusion: Compared with TACE alone, HAIC + TACE may be more safe and provide more benefits for HCC patients complicated with PVTT in the trunk.