Transarterial Chemoembolization Plus Lenvatinib and PD-1 Inhibitors for Hepatocellular Carcinoma with Main Trunk Portal Vein Tumor Thrombus: A Multicenter Retrospective Study

Figures & data

Table 1 Baseline Demographic and Clinical Characteristics of Patients with VP4

	Number (N=41)
Gender
Female	4 (9.8)
Male	37 (90.2)
Age	n (%)
<65	36 (87.8)
≥65	5 (12.2)
Child-Pugh
A	32 (78.0)
B	9 (22.0)
ECOG-PS, score
0–1	39 (95.1)
2	2 (4.9)
Platelet, (×10^9/L)
<100	5 (12.2)
≥100	36 (87.8)
Total bilirubin, µmol/L
<34	38 (92.7)
≥34	3 (7.3)
Albumin g/L
<35	10 (24.4)
≥35	31 (75.6)
ALT, IU/L
<40	18 (43.9)
≥40	23 (56.1)
AST, IU/L
<40	8 (19.5)
≥40	33 (80.5)
ALBI grade
1	12 (29.3)
2	29 (70.7)
AFP, ng/mL
<400	14 (34.1)
≥400	27 (65.9)
Maximum tumor size, cm
<5	4 (9.8)
≥5	37 (90.2)
Anti-PD-1 antibodies
Sintilimab	15 (36.6)
Tislelizumab	20 (48.8)
Camrelizumab	6(14.6)
Tumor number
Solitary	10 (24.4)
Multiple	31 (75.6)
Operation
Yes	12 (29.3)
No	29 (70.7)
Extrahepatic metastases
Yes	3 (7.3)
No	38 (92.7)
HBsAg
Negative	0 (0.00)
Positive	41 (100.0)

Abbreviations: ECOG PS, Eastern Cooperative Oncology Group Performance Status; ALT, alanine transaminase; AST, aspartate transaminase; ALBI, albumin-bilirubin; AFP, ɑ-fetoprotein; HBsAg, hepatitis B surface antigen.

Figure 1 Overall Survival (A) and Progression-Free Survival (B) for All Patients.

Table 2 Univariate and Multivariate Analysis of the Prognostic Factors for OS in All Patients

Variable	Univariate		Multivariate
	HR (95% CI)	P value	HR (95% CI)	P value
Gender	1.777 (0.126–2.522)	0.453
Male
Female
Age	1.408 (0.561–2.512)	0.655
<65
≥65
Child-Pugh	0.642 (0.350–6.941)	0.561
A
B
ECOG-PS	0.258 (0.430–2.719)	0.218
0–1
2
Platelet (10^9/L)	0.998 (0.994–1.003)	0.493
≥100
<100
Total bilirubin (µmol/L)	0.981 (0.934–1.031)	0.457
≥34
<34
Albumin (g/L)	1.003 (0.895–1.124)	0.956
≥35
<35
ALT (IU/L)	0.908 (0.511–1.495)	0.704
≥40
<40
AST (IU/L)	0.737 (0.390–1.393)	0.347
≥40
<40
ALBI grade	1.051 (0.598–1.757)	0.929
≥2
1
AFP (ng/mL)	0.300 (0.291–1.033)	0.063
≥400
<400
Maximum tumor size (cm)	0.543 (0.267–2.034)	0.556
≥5
<5
Anti-PD-1 antibodies	1.726 (0.267–3.864)	0.732
Sintilimab
Tislelizumab
Camrelizumab
Tumor number	1.910 (0.906–4.027)	0.089
Solitary
Multiple
Operation	3.731 (1.038–13.407)	0.044	3.731 (1.038–13.407)	0.044
Yes
No
Extrahepatic metastasis	2.837 (0.327–4.583)	0.344
Yes
No

Note: Bold values is to highlight the meaningful p-values.

Abbreviations: OS, overall survival; HR, hazard ratio; CI, confidence interval; ECOG PS, Eastern Cooperative Oncology Group Performance Status; ALT, alanine transaminase; AST, aspartate transaminase; ALBI, albumin-bilirubin; AFP, ɑ-fetoprotein; HBsAg, hepatitis B surface antigen.

Table 3 Univariate and Multivariate Analysis of the Prognostic Factors for PFS in All Patients

Variable	Univariate		Multivariate
	HR (95% CI)	P value	HR (95% CI)	P value
Gender	0.400 (0.134–1.196)	0.101
Male
Female
Age	0.335 (0.813–3.671)	0.155
≥65
<65
Child-Pugh	0.740 (0.271–2.019)	0.556
A
B
ECOG-PS	0.682 (0.306–1.520)	0.350
0–1
2
Platelet (×10^9/L)	0.954 (0.216–4.213)	0.951
≥100
<100
Total bilirubin (umol/L)	0.909 (0.207–3.981)	0.899
≥34
<34
Albumin (g/L)	1.340 (0.451–3.988)	0.598
≥35
<35
ALT (IU/L)	0.204 (0.606–1.372)	0.657
≥40
<40
AST (IU/L)	0.989 (0.628–1.610)	0.982
≥40
<40
ALBI grade (≥2 vs 1)	0.894 (0.607–1.473)	0.805
≥2
1
AFP (ng/mL)	1.316 (0.574–1.325)	0.520
≥400
<400
Maximum tumor size (cm)	0.940 (0.560–1.899)	0.921
≥5
<5
Anti-PD-1 antibodies	0.836 (0.256–1.632)	0.687
Sintilimab
Tislelizumab
Camrelizumab
Tumor number	0.340 (0.993–2.963)	0.053
Solitary
Multiple
Operation	3.492 (1.164–10.475)	0.026	3.492 (1.164–10.475)	0.026
Yes
No
Extrahepatic metastasis	2.514 (0.554–11.411)	0.332
Yes
No

Note: Bold values is to highlight the meaningful p-values.

Abbreviations: PFS, progression-free survival; HR, hazard ratio; CI, confidence interval; ECOG PS, Eastern Cooperative Oncology Group Performance Status; ALT, alanine transaminase; AST, aspartate transaminase; ALBI, albumin-bilirubin; AFP, ɑ-fetoprotein; HBsAg, hepatitis B surface antigen.

Figure 2 Overall Survival (A) and Progression-Free Survival (B) for Patients Who Underwent Surgery.

Table 4 Characteristics of 12 Patients Before and After Surgery

Patient No.	Tumor Thrombus Regression	Surgical Method for Thrombus	Intrahepatic Tumor pCR	Tumor Thrombus pCR	Recurrence	Recurrence Site
1	Yes	En bloc resection	No	No	No
2	Yes	En bloc resection	No	No	No
3	Yes	Extraction	No	No	Yes	Lung
4	Yes	Extraction	No	No	Yes	Liver
5	Yes	En bloc resection	Yes	Yes	No
6	No	Not extraction	No	Yes	No
7	Yes	En bloc resection	No	No	Yes	Liver
8	Yes	En bloc resection	Yes	Yes	No
9	No	Not extraction	No	Yes	Yes	Liver
10	No	Not extraction	No	Yes	Yes	Liver
11	Yes	Extraction	Yes	Yes	No
12	No	Extraction	No	Yes	No

Abbreviation: pCR, pathological complete response.

Table 5 Treatment-Related Adverse Events

Adverse Events	Any Grade n(%)	Grade 1–2 n(%)	Grade 3 n(%)	Grade 4 n(%)
Total	35(85.3)	28(68.3)	7(17.0)	–
Fatigue	10(24.4)	8(19.5)	2(4.9)	–
Decreased appetite	10(24.4)	7(17.1)	3(7.3)	–
Fever	13(31.7)	12(29.3)	1(2.4)	–
Nausea	7(17.1)	6(14.6)	1(2.5)	–
Vomiting	4(9.8)	3(7.3)	1(2.5)	–
Abdominal pain	5(12.2)	4(9.7)	1(2.5)	–
Hand-foot syndrome	6(14.8)	4(9.8)	1(2.5)	1(2.5)
Diarrhea	5(12.2)	5(12.2)	–	–
Hypertension	11(26.8)	9(21.9)	2(4.9)	–
Proteinuria	5(12.2)	3(7.2)	1(2.5)	1(2.5)
Skin rash	7(17.1)	5(12.1)	1(2.5)	1(2.5)
Thrombocytopenia	6(14.6)	6(14.6)	–	–
Hypothyroidism	7(17.1)	5(12.1)	2(5.0)	–
Abnormal liver function	26(63.4)	21(51.2)	4(9.7)	1(2.5)