{ "abstract": "Background\n\nTo compare the efficacy and safety of combined locoregional and systemic therapy vs systemic therapy alone in patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT).Methods\n\nThis multicenter retrospective study included 337 patients with HCC and PVTT who received systemic therapy alone (n=121) or combined locoregional and systemic therapy (n=216). Propensity score matching (PSM) was performed to reduce baseline imbalances. Overall survival (OS), progression-free survival (PFS), tumor response and adverse events (AEs) were compared. When the proportional hazards assumption was violated, time-varying Cox and restricted mean survival time (RMST) analyses were performed.Results\n\nIn the whole cohort, combined therapy was associated with a lower hazard of death (hazard ratio [HR]=0.57, 95% confidence interval [CI]=0.38-0.86, P=0.007), and this association remained after PSM (HR=0.54, 95% CI=0.34-0.86, P=0.009). Conventional Kaplan-Meier analysis did not show a significant PFS difference after PSM (median PFS, 12.97 vs 10.20 months; P=0.394); however, the proportional hazards assumption for PFS was violated. RMST analyses showed significant cumulative PFS advantages favoring combined therapy at 12 months (+1.48 months; P=0.008) and 16 months (+1.69 months; P=0.010). After PSM, the objective response rate according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) was higher with combined therapy (61.1% vs 45.4%, P=0.029). In patients with Vp3-4 PVTT, combined therapy was associated with a lower hazard of death (HR=0.60, 95% CI=0.39-0.93, P=0.023). Grade 3-4 AEs were comparable between groups (29.2% vs 31.4%, P=0.759).Conclusion\n\nCombined locoregional and systemic therapy was associated with longer OS and an early, time-dependent PFS advantage compared with systemic therapy alone in patients with HCC and PVTT, with a more apparent OS benefit signal in Vp3-4 disease and no clear increase in grade 3-4 AEs.", "abstract_shown": true, "affiliations": [ "Department of Hepatic Surgery II, Third Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital), Shanghai, People's Republic of China.", "Department of Hepatopancreatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, People's Republic of China.", "Hepato-Pancreato-Biliary Center, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, People's Republic of China.", "Department of Hepatobiliary Surgery, The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's Hospital), Zhengzhou, Henan, People's Republic of China.", "Department of Hepatic Surgery IV, Third Affiliated Hospital of Naval Medical University (Eastern Hepatobiliary Surgery Hospital), Shanghai, People's Republic of China.", "Department of Liver Surgery and Transplantation, Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.", "Department of General Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, People's Republic of China." ], "article_type": "research article", "arxiv": null, "author_total": 13, "authors": [ { "affs": [ 0 ], "name": "Jianwei Liu" }, { "affs": [ 0 ], "name": "Yuxuan Lin", "orcid": "0000-0002-4455-0771" }, { "affs": [ 1 ], "name": "Kongying Lin", "orcid": "0000-0001-8886-4054" }, { "affs": [ 0 ], "name": "Kang Liang", "orcid": "0009-0001-2111-2832" }, { "affs": [ 2 ], "name": "Zhengqing Lei" }, { "affs": [ 0 ], "name": "Hui Xue" }, { "affs": [ 3 ], "name": "Huifeng Wang" }, { "affs": [ 4 ], "name": "Yong Xia" }, { "affs": [ 5 ], "name": "Hui-Chuan Sun" }, { "affs": [ 6 ], "name": "Anfeng Si" }, { "affs": [ 1 ], "name": "Yongyi Zeng" }, { "affs": [ 0 ], "name": "Kui Wang" }, { "name": "China Liver Cancer Study Group Young Investigators (CLEAP)" } ], "bibtex": "https://research.draconitic.com/paper/dsj3g18scwhkh.bib", "cited_by": 0, "doi": "10.2147/jhc.s624104", "fulltext_url": "https://europepmc.org/articles/PMC13691932", "id": "dsj3g18scwhkh", "issns": [ "2253-5969" ], "landing_url": "https://europepmc.org/article/MED/42921173", "language": "eng", "licence": "CC-BY-NC", "licence_label": "CC BY-NC", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2721|Hepatocellular Carcinoma Treatment and Prognosis" ] ], "openalex": "W7222028082", "pdf_url": "https://europepmc.org/articles/PMC13691932?pdf=render", "pmcid": "PMC13691932", "pmid": "42921173", "published": "2026-10-16", "publisher": null, "ris": "https://research.draconitic.com/paper/dsj3g18scwhkh.ris", "sources": [ { "first_seen": "2026-10-30T12:20:33Z", "native_id": "MED:42921173", "source": "europepmc", "url": "https://europepmc.org/article/MED/42921173" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2721|Hepatocellular Carcinoma Treatment and Prognosis", "subfield": "general" } ], "title": "The Efficacy and Safety of Combined Locoregional and Systemic Therapy versus Systemic Therapy Alone in Patients with Hepatocellular Carcinoma and Portal Vein Tumor Thrombosis: A Multicenter Real-World Retrospective Cohort Study.", "title_text": "The Efficacy and Safety of Combined Locoregional and Systemic Therapy versus Systemic Therapy Alone in Patients with Hepatocellular Carcinoma and Portal Vein Tumor Thrombosis: A Multicenter Real-World Retrospective Cohort Study.", "type": "peer-reviewed", "updated_at": "2026-10-30T12:20:33Z", "url": "https://research.draconitic.com/paper/dsj3g18scwhkh", "venue": "Journal of hepatocellular carcinoma", "versions": [] }