BJS Open. 2025 Mar 5;10(2):zrag007. doi: 10.1093/bjsopen/zrag007.
ABSTRACT
BACKGROUND: Portal vein tumour thrombus (PVTT) significantly worsens the prognosis of hepatocellular carcinoma. Although combination therapy involving immune checkpoint inhibitors, anti-angiogenics, and locoregional treatment has shown promising anti-tumour activity, the comparative effectiveness of liver resection versus transarterial chemoembolization within such regimens remains unclear.
METHODS: This multicentre, retrospective study enrolled patients with hepatocellular carcinoma and PVTT who received either liver resection or transarterial chemoembolization, each combined with PD-1 inhibitors and lenvatinib (LRPL and TPL, respectively), between 2019 and 2023. Survival outcomes were compared using the Kaplan-Meier method. Propensity score matching was applied to balance baseline characteristics and reduce potential confounding between the two groups.
RESULTS: A total of 430 patients were included, and 155 patients remained in each cohort after 1:1 propensity score matching. The LRPL cohort showed significantly longer overall survival than the TPL cohort, with a median(interquartile range) overall survival of 34.0 (30.0-45.9) months versus 22.9 (19.3-31.2) months (hazard ratio 0.71, 95% confidence interval 0.53 to 0.95; P < 0.001). Subgroup analysis revealed that the overall survival benefit of LRPL was primarily observed in patients with PVTT limited to secondary branches (hazard ratio 0.36, 0.21 to 0.64; P < 0.001). In contrast, no significant difference was found when PVTT involved the primary branches or main trunk (hazard ratio 0.91, 0.68 to 1.41; P = 0.240).
CONCLUSIONS: The LRPL strategy was associated with superior survival compared with TPL, especially in patients with secondary branch PVTT, indicating its potential as the preferred therapeutic option for this patient population.
PMID:41871372 | DOI:10.1093/bjsopen/zrag007