Liver resection versus transarterial chemoembolization plus PD-1 inhibitors and lenvatinib for hepatocellular carcinoma with portal vein tumour thrombus.

The LRPL cohort showed significantly longer overall survival than the TPL cohort after propensity score matching.

• Median overall survival was 34.0 (IQR 30.0–45.9) months in the LRPL cohort versus 22.9 (IQR 19.3–31.2) months in the TPL cohort.
• Hazard ratio for overall survival was 0.71 (95% CI 0.53 to 0.95; P < 0.001).
• Survival outcomes were compared using the Kaplan-Meier method.
• Propensity score matching (1:1) was applied, leaving 155 patients in each cohort from an original total of 430 patients.

The overall survival benefit of LRPL over TPL was primarily observed in patients with PVTT limited to secondary branches.

• Hazard ratio for overall survival in patients with secondary branch PVTT was 0.36 (95% CI 0.21 to 0.64; P < 0.001), indicating a substantial survival advantage for LRPL.
• This subgroup analysis was performed to assess differential effects based on PVTT anatomical extent.
• The finding suggests LRPL may be the preferred therapeutic option specifically for patients with secondary branch PVTT.

No significant overall survival difference was found between LRPL and TPL when PVTT involved the primary branches or main trunk.

• Hazard ratio for overall survival in patients with primary branch or main trunk PVTT was 0.91 (95% CI 0.68 to 1.41; P = 0.240).
• This indicates that the survival advantage of liver resection over TACE-based combination therapy was not observed in more advanced PVTT involvement.
• This finding was derived from subgroup analysis stratified by PVTT classification.

This study was a multicentre, retrospective design enrolling patients with hepatocellular carcinoma and PVTT treated between 2019 and 2023.

• A total of 430 patients were included across multiple centres.
• Patients received either liver resection combined with PD-1 inhibitors and lenvatinib (LRPL) or transarterial chemoembolization combined with PD-1 inhibitors and lenvatinib (TPL).
• Propensity score matching was applied to balance baseline characteristics and reduce potential confounding between groups.
• After 1:1 propensity score matching, 155 patients remained in each cohort.

Portal vein tumour thrombus significantly worsens the prognosis of hepatocellular carcinoma, and combination therapy with immune checkpoint inhibitors, anti-angiogenics, and locoregional treatment has shown promising anti-tumour activity.

• The comparative effectiveness of liver resection versus transarterial chemoembolization within such combination regimens was previously unclear.
• PD-1 inhibitors served as the immune checkpoint inhibitor component and lenvatinib as the anti-angiogenic component in both treatment arms.
• The study was motivated by the need to clarify which locoregional approach is superior within these modern combination regimens.