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Background <p>This retrospective study aimed to evaluate the safety and effectiveness of hepatic arterial infusion chemotherapy with raltitrexed and oxaliplatin (RALOX-HAIC) combined with radiotherapy, tyrosine kinase inhibitors, and immune checkpoint inhibitors in patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).</p> Methods <p>A propensity score-matching (PSM) cohort study was conducted. The tumor response, treatment-related adverse events, survival outcomes were compared. Univariate and multivariate analyses were conducted to explore the risk factors of overall survival (OS).</p> Results <p>Twenty-one pairs of patients were evaluated after PSM. No statistical differences were found in the tumor response, objective response rate, disease control rate, PVTT response, surgical resection rate, metastasis, and mortality between the two groups before and after PSM. Compared with the FOLFOX-HAIC group, the incidences of abdominal pain and fever was lower in the RALOX-HAIC group (P = 0.028, P = 0.029). These differences still had statistical significance after PSM (P = 0.013, P = 0.014). No statistical differences were found in OS and progression-free survival (PFS) between the two groups before and after PSM (Before [OS: hazard ratio(HR) = 1.138; 95%CI 0.569–2.276, P = 0.715; PFS: HR = 0.549; 95%CI 0.195–1.548, P = 0.257; After [OS: HR = 0.998; 95%CI 0.438–2.274, P = 0.995; PFS: HR = 0.792; 95%CI 0.359–1.748, P = 0.564]). The prealbumin &lt; 170&#xa0;mg/L before therapy was an independent risk factor for OS (HR = 2.234; 95%CI 1.051–4.751; P = 0.037).</p> Conclusions <p>The RALOX-HAIC combined radiotherapy, TKI, and ICI may provide similar survival advantages with fewer treatment-related abdominal pain and fever compared to FOLFOX-HAIC for HCC patients with PVTT. The prealbumin &lt; 170&#xa0;mg/L before therapy is an independent risk factor for OS.</p>

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Radiotherapy, tyrosine kinase inhibitors, immune checkpoint inhibitors combined with hepatic arterial infusion chemotherapy of RALOX versus FOLFOX for hepatocellular carcinoma with portal vein tumor thrombus: a propensity score-matching cohort study

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  • 发表日期：

    2025年5月10日

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  • Hao-yang Tan,
  • Shuang-quan Liu,
  • Yan-han Liu,
  • Guo-hua Dai,
  • Jiu-ling Zheng,
  • Hua-guo Feng

摘要

Background

This retrospective study aimed to evaluate the safety and effectiveness of hepatic arterial infusion chemotherapy with raltitrexed and oxaliplatin (RALOX-HAIC) combined with radiotherapy, tyrosine kinase inhibitors, and immune checkpoint inhibitors in patients with hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT).

Methods

A propensity score-matching (PSM) cohort study was conducted. The tumor response, treatment-related adverse events, survival outcomes were compared. Univariate and multivariate analyses were conducted to explore the risk factors of overall survival (OS).

Results

Twenty-one pairs of patients were evaluated after PSM. No statistical differences were found in the tumor response, objective response rate, disease control rate, PVTT response, surgical resection rate, metastasis, and mortality between the two groups before and after PSM. Compared with the FOLFOX-HAIC group, the incidences of abdominal pain and fever was lower in the RALOX-HAIC group (P = 0.028, P = 0.029). These differences still had statistical significance after PSM (P = 0.013, P = 0.014). No statistical differences were found in OS and progression-free survival (PFS) between the two groups before and after PSM (Before [OS: hazard ratio(HR) = 1.138; 95%CI 0.569–2.276, P = 0.715; PFS: HR = 0.549; 95%CI 0.195–1.548, P = 0.257; After [OS: HR = 0.998; 95%CI 0.438–2.274, P = 0.995; PFS: HR = 0.792; 95%CI 0.359–1.748, P = 0.564]). The prealbumin < 170 mg/L before therapy was an independent risk factor for OS (HR = 2.234; 95%CI 1.051–4.751; P = 0.037).

Conclusions

The RALOX-HAIC combined radiotherapy, TKI, and ICI may provide similar survival advantages with fewer treatment-related abdominal pain and fever compared to FOLFOX-HAIC for HCC patients with PVTT. The prealbumin < 170 mg/L before therapy is an independent risk factor for OS.