Transarterial Chemoembolization Combined With Apatinib Plus PD-1 Inhibitors for Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Multicenter Retrospective Study

Abstract Purpose: To compare transarterial chemoembolization (TACE) combined with apatinib and PD-1 inhibitor (TACE-AP) with TACE combined with apatinib alone (TACE-A) in the treatment of hepatocellular carcinoma (HCC) with portal tumor thrombus (PVTT) and to explore the prognostic factors affecting the survival of patients. Patients and methods: This retrospective study analyzed data of HCC patients with PVTT who were treated with TACE-AP or TACE-A between January 2018 and June 2021. The primary endpoints of the study were progression-free survival (PFS) and overall survival (OS), and secondary endpoints were objective response rate (ORR) and adverse events (AEs). Propensity score matching (PSM) and inverse probability weighting (IPTW) analysis were used to reduce patient selection bias, and COX regression analysis was used to analyze prognostic factors affecting patient survival. Results: Sixty-nine and 40 patients were included in the TACE-A and TACE-AP group, respectively. After PSM and IPTW analysis, the median PFS and median OS in the TACE-AP group were significantly higher than those in the TACE-A group (PFS: after PSM, 6.9 months vs 4.0 months, P < 0.001, after IPTW, 6.5 months vs 5.1 months, P < 0.001; OS: after PSM,14.6 months vs 8.5 months P < 0.001, after IPTW, 16.1 months vs 10.5 months, P < 0.001). After PSM and IPTW, the tumor ORR in the TACE-AP group was significantly higher than that in the TACE-A group (PSM, 53.6% VS 17.9%, P = 0.005; IPTW, 52.5% vs 28.6%, P = 0.013). All treatment-related adverse reactions (AEs) were observed to be tolerated. Multivariate Cox regression analysis showed that the main prognostic factors affecting the survival of patients were tumor number, PVTT type, AFP, and treatment mode. Conclusion: In the treatment of HCC patients with PVTT, TACE-AP significantly improved PFS, OS and ORR, and the AEs were safe and controllable.