Hepatocellular carcinoma with main portal vein invasion: systemic therapy alone or in combination with local transarterial chemoembolization treatment

Abstract

Purpose To compare the safety and efficacy of systemic therapy alone or in combination with local transarterial chemoembolization (TACE) treatment for patients with advanced hepatocellular carcinoma (HCC) and main portal vein (MPV) invasion. Patients and Methods: Between May 2019 and December 2021, 73 consecutive patients with advanced HCC and MPV invasion either received systemic medical therapy alone (i.e., molecular targeted therapy plus immunotherapy, S group, n = 34) or in combination with TACE treatment (S-T group, n = 39). The primary outcome was overall survival (OS), and the secondary outcomes were progression-free survival (PFS) and treatment response. Adverse events (AEs) related to treatment were also recorded. Survival curves were constructed with the Kaplan‒Meier method and compared using the log-rank test. Results The baseline characteristics were comparable between the two groups. The mean number of TACE sessions per patient was 2.6 (range 1–4). Although no TACE-related deaths occurred, 13 AEs of grade 3–4 occurred in the S-T group. The median OS was 10.0 months and 8.0 months in the S-T group and S group, respectively (P = 0.254). The median PFS between the two groups was similar (4.0 months vs. 4.0 months, P = 0.404). The disease control rate between the S-T and S group was comparable (64.1% vs. 67.6%, P = 0.750). Conclusions The results demonstrated that additional TACE treatment did not yield survival benefits compared to systemic medical therapy alone for patients with advanced HCC and MPV invasion. Considering the complications related to TACE, systemic medical therapy seems appropriate for managing those patients.