Clin Mol Hepatol.
2023 Jul;29(3):763-778. 10.3350/cmh.2023.0076.
Transarterial radioembolization versus tyrosine kinase inhibitor in hepatocellular carcinoma with portal vein thrombosis
- Affiliations
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- 1Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea
- 2Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
- 3Department of Internal Medicine and Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- 4Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- 5Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- 6Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- 7Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- 8Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
- 9Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
- 10Department of Radiology, National Cancer Center, Goyang, Korea
- KMID: 2543993
- DOI: http://doi.org/10.3350/cmh.2023.0076
Abstract
- Background/Aims
Transarterial radioembolization (TARE) has shown promising results in treating advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). However, whether TARE can provide superior or comparable outcomes to tyrosine kinase inhibitor (TKI) in patients with HCC and PVTT remains unclear. We compared the outcomes of TARE and TKI therapy in treatment-naïve patients with locally advanced HCC and segmental or lobar PVTT.
Methods
This multicenter study included 216 patients initially treated with TARE (n=124) or TKI (sorafenib or lenvatinib; n=92) between 2011 and 2021. Baseline characteristics were balanced using propensity score matching (PSM) or inverse probability of treatment weighting (IPTW). The primary outcome was overall survival (OS). The secondary outcomes included progression-free survival (PFS) and objective response rate (ORR).
Results
In the unmatched cohort, the median OS of the TARE and TKI groups were 28.2 and 7.2 months, respectively (p<0.001), and the TARE group experienced significantly and independently longer OS compared to the TKI group (adjusted hazard ratio=0.41, 95% confidence interval=0.28–0.60, p<0.001). Similar results were observed in the study cohorts balanced with IPTW (p=0.003) or PSM (p=0.004). Although PFS was comparable between the two groups, the TARE group showed a trend of prolonged PFS in a subpopulation of patients with Vp1 or Vp2 PVTT (p=0.052). In the matched cohorts, the ORR of the TARE group was 53.0–56.7%, whereas that of the TKI group was 12.3–15.0%.
Conclusions
For patients with advanced HCC with segmental or lobar PVTT and well-preserved liver function, TARE may provide superior OS compared to sorafenib or lenvatinib.
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