Transjugular intrahepatic portosystemic shunt plus sequential systemic therapy for advanced hepatocellular carcinoma with tumor thrombus-related symptomatic portal hypertension: A multicenter retrospective study.

e16116 Background: Portal vein tumor thrombus (PVTT) and symptomatic portal hypertension severely affect the survival and quality of life of hepatocellular carcinoma (HCC) patients. The aim of this study was to evaluate the clinical outcomes of the transjugular intrahepatic portosystemic shunt (TIPS) plus sequential systemic therapy in advanced HCC patients with tumor thrombus-related symptomatic portal hypertension. Methods: This multi-center retrospective study explored 142 advanced HCC patients with PVTT and symptomatic portal hypertension who received either TIPS plus sequential systemic therapy (group A) or only symptomatic and supportive treatment (group B) for from April 2016 to January 2020. The Kaplan-Meier method and log-rank test were performed to determine the survival differences of variables. Univariable and multivariable Cox proportional hazards regression analyses were used to identify prognostic factors of overall survival (OS). We used independent factors for the nomogram to predict OS. Results: The median OS of group A was significantly better than that of group B (7.6 [95% CI: 4.6, 10.6] vs. 4.5 [95% CI: 2.7, 6.4], months, P < 0.001). Multivariable analysis also showed that PVTT degree (I/II) (Hazard ratios [HR] = 0.679; 95% CI: 0.465, 0.994; P = 0.046), variceal bleeding (HR = 1.686; 95% CI: 1.059, 2.684; P = 0.028), Child-Pugh Class A (HR = 0.450; 95% CI: 0.272, 0.746; P = 0.002), and BCLC stage C (HR = 0.434; 95% CI: 0.222, 0.850; P = 0.015) were significant predictors of OS. These five indicators were included in the nomogram model to predict survival probabilities in 6- and 12-months OS. Conclusions: TIPS plus sequential systemic therapy is safe and feasible for the treatment of advanced HCC with tumor thrombus-related symptomatic portal hypertension.