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Abstract：
Background/purpose: The prognosis of hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) is generally poor and hepatectomy is optional for these patients. This study aims to explore the survival benefits of neoadjuvant hepatic arterial infusion chemotherapy (HAIC) for resectable HCC with PVTT. Methods: This retrospective study included 120 resectable HCC patients with PVTT who underwent hepatectomy, from January 2017 to January 2021 at Sun Yat-sen University Cancer Center. Of these patients, the overall survival (OS) and recurrence-free survival (RFS) of 55 patients who received hepatectomy alone (Surgery group) and 65 patients who received neoadjuvant HAIC followed by hepatectomy (HAIC-Surgery group) were compared. Logistic regression analysis was conducted to develop a model predicting the response to neoadjuvant HAIC. Results: The OS rates for the HAIC-Surgery group at 1, 3, and 5 years were 94.9%, 78%, and 66.4%, respectively, compared with 84.6%, 47.6%, and 37.2% in the Surgery group (p < 0.001). The RFS rates were 88.7%, 56.2%, and 38.6% versus 84.9%, 38.3%, and 22.6% (p = 0.002). The subgroup analysis revealed that the survival benefit of neoadjuvant HAIC was limited to patients who responded to it. The logistic model, consisting of AFP and CRP, that predicted the response to neoadjuvant HAIC performed well, with an area under the ROC curve (AUC) of 0.756. Conclusion: Neoadjuvant HAIC followed by hepatectomy is associated with a longer survival outcome than hepatectomy alone for HCC patients with PVTT and the survival benefit is limited to patients who respond to neoadjuvant FOLFOX-HAIC.
摘要：
背景/目的：肝细胞癌（HCC）合并门静脉癌栓（PVTT）患者的预后通常较差，对这些患者进行肝切除术是可选的。本研究旨在探讨新辅助肝动脉灌注化疗（HAIC）对可切除的肝癌合并PVTT的生存益处。方法：这项回顾性研究包括120例可切除的肝癌患者，并接受肝切除术，2017年1月至2021年1月在中山大学肿瘤防治中心。在这些病人中,比较了55例仅接受肝切除术(手术组)的患者和65例接受新辅助HAIC后肝切除术(HAIC-手术组)的患者的总生存期(OS)和无复发生存期(RFS).进行Logistic回归分析以建立预测新辅助HAIC反应的模型。结果：HAIC手术组1年、3年和5年的OS率为94.9%，78%,和66.4%，分别,与84.6%相比，47.6%,手术组为37.2%(p<0.001)。RFS率为88.7%,56.2%,38.6%和84.9%，38.3%,和22.6%(p=0.002)。亚组分析显示，新辅助HAIC的生存益处仅限于对其有反应的患者。逻辑模型，由AFP和CRP组成，预测对新辅助HAIC的反应表现良好，ROC曲线下面积（AUC）为0.756。结论：对于患有PVTT的HCC患者，新辅助HAIC和肝切除术后的肝切除术与更长的生存结果相关，并且生存益处仅限于对新辅助FOLFOX-HAIC有反应的患者。
