This study aimed to compare the treatment outcomes of atezolizumab-plus-bevacizumab (Ate/Bev) therapy with those of transarterial chemoembolization plus radiotherapy (TACE + RT) in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) and without metastasis. Between June 2016 and October 2022, we consecutively enrolled 855 HCC patients with PVTT. After excluding 758 patients, 97 patients (n = 37 in the Ate/Bev group; n = 60 in the TACE + RT group) were analyzed. The two groups showed no significant differences in baseline characteristics and had similar objective response and disease control rates. However, the Ate/Bev group showed a significantly higher one-year survival rate (p= 0.041) compared to the TACE + RT group, which was constantly displayed in patients with extensive HCC burden. Meanwhile, the clinical outcomes were comparable between the two groups in patients with unilobar intrahepatic HCC. In Cox-regression analysis, Ate/Bev treatment emerged as a significant factor for better one-year survival (p= 0.049). Finally, in propensity-score matching, the Ate/Bev group demonstrated a better one-year survival (p= 0.02) and PFS (p= 0.01) than the TACE + RT group. In conclusion, Ate/Bev treatment demonstrated superior clinical outcomes compared to TACE + RT treatment in HCC patients with PVTT. Meanwhile, in patients with unilobar intrahepatic HCC, TACE + RT could also be considered as an alternative treatment option alongside Ate/Bev therapy.
本研究旨在比较阿替利珠单抗联合贝伐珠单抗（Ate/Bev）疗法与经动脉化疗栓塞联合放疗（TACE + RT）在伴有门静脉癌栓（PVTT）且无远处转移的肝细胞癌（HCC）患者中的治疗效果。2016年6月至2022年10月期间，我们连续纳入855例伴有PVTT的HCC患者。排除758例患者后，对97例患者（Ate/Bev组37例；TACE + RT组60例）进行分析。两组患者的基线特征无显著差异，客观缓解率和疾病控制率相近。然而，与TACE + RT组相比，Ate/Bev组的一年生存率显著更高（p=0.041），这一优势在肿瘤负荷较大的HCC患者中持续显现。同时，对于肝内单叶型HCC患者，两组的临床结局相当。在Cox回归分析中，Ate/Bev治疗是改善一年生存率的显著因素（p=0.049）。最后，在倾向性评分匹配分析中，Ate/Bev组的一年生存率（p=0.02）和无进展生存期（p=0.01）均优于TACE + RT组。综上所述，对于伴有PVTT的HCC患者，Ate/Bev治疗相较于TACE + RT治疗展现出更优的临床结局。同时，对于肝内单叶型HCC患者，TACE + RT也可作为Ate/Bev疗法之外的替代治疗选择。
肿瘤(癌症)患者之家