Stereotactic body radiotherapy plus lenvatinib and sintilimab with and without transarterial embolization for advanced hepatocellular carcinoma with portal vein tumor thrombus: a dual-center, propensity score-matched retrospective analysis.

The TAE group showed significantly longer median progression-free survival compared to the non-TAE group after propensity score matching.

• Median PFS was 11.0 months in the TAE group versus 6.0 months in the non-TAE group
• HR = 0.71, p = 0.044
• PSM resulted in 64 patients per group from an original cohort of 204 patients
• Multivariate analysis confirmed TAE as an independent predictor of reduced risk of progression (HR = 0.52, 95% CI: 0.36–0.76)

Local control showed a trend toward improvement in the TAE group compared to the non-TAE group, though not statistically significant.

• Median local control was 51.0 months in the TAE group versus 36.0 months in the non-TAE group
• HR = 0.54, p = 0.066
• The p-value did not reach conventional statistical significance

Overall survival was comparable between the TAE and non-TAE groups.

• Median OS was 19.0 months in the TAE group versus 18.0 months in the non-TAE group
• p = 0.606, indicating no statistically significant difference
• OS was a primary endpoint of the study

Objective response rates were similar between the TAE and non-TAE groups.

• Objective response rate was 40.6% in the TAE group versus 39.1% in the non-TAE group
• p = 0.861, indicating no statistically significant difference
• ORR was a secondary endpoint of the study

Grade ≥3 treatment-related adverse events were equivalent between the two groups, and TAE did not increase hematologic or hepatic toxicity.

• Grade ≥3 treatment-related adverse events occurred in 50.0% of patients in both the TAE and non-TAE groups
• p = 0.854 for between-group comparison of severe adverse events
• TAE did not increase hematologic or hepatic toxicity, supporting its tolerability

The study population consisted of patients with Barcelona Clinic Liver Cancer stage C HCC and portal vein tumor thrombus treated at dual centers over approximately four years.

• 204 total patients were analyzed before PSM
• Patients were treated between June 2018 and December 2022
• All patients received SBRT plus lenvatinib and sintilimab, with or without TAE
• PSM was performed to balance baseline characteristics, yielding 64 patients per group

PVTT in HCC is associated with poor prognosis and limited efficacy of current first-line therapies, motivating investigation of combined locoregional and systemic strategies.

• Combining locoregional and systemic therapies may enhance antitumor immunity
• The safety and efficacy of dual locoregional therapy with SBRT and TAE combined with targeted immunotherapy was previously unclear
• This was characterized as a real-world retrospective study