Neoadjuvant-Based Triple Therapy for Hepatocellular Carcinoma with Type I/II Portal Vein Tumor Thrombosis

Purpose: Hepatectomy could provide better survival benefit for hepatocellular carcinoma (HCC) with type I/II portal vein tumor thrombosis (PVTT).However, the postoperative recurrence remains high.We discussed whether neoadjuvant therapy could reduce HCC recurrence for these patients.Patients and Methods: One hundred and thirty-eight resectable HCC with type I-II PVTT were retrospectively included.The neoadjuvant therapy regimens included tyrosine kinase inhibitor (TKI), programmed death 1(PD-1) antibodies and transarterial chemoembolization (TACE).Short-term and long-term outcomes were compared.Propensity score matching (PSM) was performed to minimize the influence of potential confounders.Results: Thirty-three patients underwent neoadjuvant therapy and 105 patients underwent surgery alone.In the neoadjuvant group, 7 (21.2%)patients achieved stable disease, 13 (39.4%)achieved partial response and 13 (39.4%)achieved complete response based on the modified Response Evaluation Criteria in Solid Tumors criterion.By PSM, the neoadjuvant therapy resulted in less microvascular invasion (24.1% vs 50.0%,P=0.021), satellite nodule (6.9% vs 24.1%, P=0.036) and less patients with alpha-fetoprotein>20(ng/mL) (37.9% vs 69.0%, P=0.006).The neoadjuvant therapy reduced tumor recurrence and prolonged survival.Multivariate analysis found that neoadjuvant therapy was an independent protective factor for overall survival and recurrence free survival.Conclusion: Neoadjuvant treatment presents a promising treatment option for HCC patients with type I/II PVTT.