Efficacy and safety of transarterial chemoembolization combined with donafenib and camrelizumab for hepatocellular carcinoma with portal vein tumor thrombus: a dual-center, retrospective propensity score-matched analysis.

AIM: To evaluate the efficacy and safety of transarterial chemoembolization combined with donafenib and camrelizumab (TACE+D+C) versus TACE plus donafenib (TACE+D) in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). METHODS: Patients with HCC complicated by PVTT diagnosed at two medical centers between December 2021 and July 2025 were enrolled and assigned to the TACE+D group and the TACE+D+C group. Propensity score matching (PSM) was performed at a 1:1 ratio with a caliper width of 0.2 standard deviations to balance baseline confounding factors, with 109 patients included in each group after matching. The primary endpoints were median overall survival (mOS) and median progression-free survival (mPFS), both calculated from the date of TACE completion. The secondary endpoints comprised objective response rate (ORR), disease control rate (DCR), and adverse events (AEs). RESULTS: A total of 109 patients were enrolled in each group following PSM. In our retrospective PSM analysis, we observed that the TACE+D+C group was associated with longer mOS (15.90 vs 9.10 months, P < 0.001) and mPFS (11.20 vs 7.10 months, P < 0.001) relative to the TACE+D group. For intrahepatic lesions, the TACE+D+C group was associated with markedly higher ORR (58.72% vs 36.70%, P = 0.001) and DCR (89.91% vs 77.06%, P = 0.011). In terms of PVTT, the TACE+D+C group also presented higher ORR (42.20% vs 23.85%, P = 0.004) and DCR (77.06% vs 64.22%, P = 0.037). The incidence of AEs after TACE was similar in both groups; mild grade 1-2 immune-related adverse events (irAEs) unique to camrelizumab were only detected in the TACE+D+C group, with no severe grade 3-4 irAEs recorded. CONCLUSION: This retrospective PSM analysis observed a correlation between TACE+D+C triple therapy and longer survival and higher tumor response among PVTT-positive HCC patients. Given the inherent limitations of a retrospective observational design, these results cannot establish therapeutic superiority, and prospective randomized controlled trials are warranted to validate causal clinical benefits.