HAIC-Based versus TACE-Based Triple Therapy with Lenvatinib and PD-1 Inhibitors for Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: A Retrospective Propensity Score-Matched Study.

BACKGROUND: The optimal locoregional treatment to combine with lenvatinib and PD-1 inhibitors for hepatocellular carcinoma with portal vein tumor thrombus (PVTT-HCC) remains uncertain. We compared HAIC- and TACE-based triple therapy. METHODS: This retrospective single-center study included 359 consecutive patients with PVTT-HCC treated with HAIC or TACE plus lenvatinib and a PD-1 inhibitor. Propensity score matching (PSM) was performed at a 1:1 ratio. Tumor response was assessed using mRECIST. Overall survival (OS), progression-free survival (PFS), conversion-to-surgery, and adverse events were compared. Time-dependent Cox models accounted for cumulative locoregional treatment sessions. RESULTS: Among 359 patients, 161 received TACE-based therapy and 198 received HAIC-based therapy. After PSM, 139 matched pairs were analyzed. HAIC was associated with higher objective response rate (66.91% vs 42.45%) and disease control rate (82.73% vs 62.59%) than TACE (both P<0.001). Median OS was 23.7 versus 17.1 months (HR 0.67, 95% CI 0.48-0.93; P=0.018), and median PFS was 7.7 versus 5.4 months (HR 0.70, 95% CI 0.54-0.91; P=0.008), favoring HAIC. After time-dependent adjustment, HAIC remained associated with improved OS (HR 0.61; P=0.003) and PFS (HR 0.73; P=0.011). Conversion-to-surgery was more frequent with HAIC (27.3% vs 17.4%; P=0.027). Overall adverse-event rates were similar (89.90% vs 88.82%; P=0.741), although hypertension was more frequent with HAIC (52.02% vs 38.51%; P=0.011). CONCLUSION: In patients with PVTT-HCC receiving lenvatinib and PD-1 inhibitors, HAIC-based triple therapy was associated with improved tumor response and longer OS and PFS than TACE-based therapy, with generally comparable safety. Prospective multicenter studies are warranted.