TACE-HAIC Plus Targeted Therapy and Immunotherapy for HCC with Tumor Thrombus and Arteriovenous Fistula

This study aimed to evaluate the clinical efficacy and safety of combined therapy (transcatheter arterial chemoembolization [TACE] with hepatic artery infusion chemotherapy [HAIC] combined with tyrosine kinase inhibitors [TKIs] and PD-1 inhibitors) versus TACE alone in hepatocellular carcinoma (HCC) patients with concurrent portal/hepatic vein tumor thrombus (PVTT/HVTT) and arteriovenous fistula (AVF).

This single-center retrospective study analyzed 301 HCC patients with PVTT/HVTT and AVF who received either combined therapy (n=177) or TACE monotherapy (n=124). Propensity score matching (PSM) was used to minimize confounding bias, yielding an average of 109 patients per group. Key outcomes compared included tumor thrombus regression rate, AVF closure rate, objective response rate (ORR), disease control rate (DCR), median overall survival (mOS), median progression-free survival (mPFS), and adverse events (AE).

After PSM, the AVF complete closure rate of the combination therapy group was significantly higher than the TACE group (63.3% vs 27.5%, p < 0.001). According to response evaluation criteria in solid tumors (RECIST) 1.1 criteria for tumor thrombus response, the combination therapy group showed higher ORR (47.7% vs 7.3%, p < 0.001) and DCR (73.4% vs 50.5%, p < 0.001) than the TACE group. The combined therapy provided longer mOS (16.70 vs 10.40 months, p < 0.0001) and mPFS (14.23 vs 8.21 months, p < 0.0001) than TACE. The incidences of grade 3/4 AE were similar in both groups, respectively, 37.6% and 33.9%, p = 0.57.

Compared with TACE monotherapy, the combined therapy is a promising option with acceptable safety for HCC patients with PVTT/HVTT and AVF.