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ORIGINAL RESEARCH

Hepatic Arterial Infusion Chemotherapy Combined with Lenvatinib and PD-1 Inhibitors for Managing Arterioportal Shunt in Hepatocellular Carcinoma with Portal Vein Tumor Thrombus: A Retrospective Cohort Study

, , , ORCID Icon, , , , ORCID Icon, & ORCID Icon show all
Pages 1415-1428 | Received 05 Feb 2024, Accepted 25 Jun 2024, Published online: 12 Jul 2024

Figures & data

Table 1 APS Classification

Table 2 Baseline Characteristics

Figure 1 Flow chart.

Abbreviations: APS, arterioportal shunt; HCC, hepatocellular carcinoma; PVTT, portal vein tumor thrombus.
Figure 1 Flow chart.

Table 3 Outcome of APS

Figure 2 Representative radiographical images of a patient who achieved APS disappearance after treatment. Images of man aged 50 years with HCC and severe APS after receiving the combination therapy. Axial contrast-enhanced CT images in the arterial phase (a) and portal phase (b) before the initiation of treatment. CT images taken during the arterial phase (a) displayed early enhancement of portal vein branches (indicated by a black arrow), representing APS. Hepatic angiography (c) revealed severe APS (indicated by a black arrow). Subsequent axial contrast-enhanced CT images in the arterial (d) and portal (e) phase were taken after three sessions of HAIC, showing no apparent APS. Hepatic angiography in image (f) confirmed the absence of APS.

Abbreviations: APS, arterioportal shunt; CT, computed tomography; HCC, hepatocellular carcinoma.
Figure 2 Representative radiographical images of a patient who achieved APS disappearance after treatment. Images of man aged 50 years with HCC and severe APS after receiving the combination therapy. Axial contrast-enhanced CT images in the arterial phase (a) and portal phase (b) before the initiation of treatment. CT images taken during the arterial phase (a) displayed early enhancement of portal vein branches (indicated by a black arrow), representing APS. Hepatic angiography (c) revealed severe APS (indicated by a black arrow). Subsequent axial contrast-enhanced CT images in the arterial (d) and portal (e) phase were taken after three sessions of HAIC, showing no apparent APS. Hepatic angiography in image (f) confirmed the absence of APS.

Figure 3 The best tumor response (A) and PVTT response (B) observed during treatment, and tumor response (C) and PVTT response (D) after two sessions of HAIC.

Abbreviations: CR, complete response; PD, progressive disease; PR, partial response; PVTT, portal vein tumor thrombus; SD, stable disease.
Figure 3 The best tumor response (A) and PVTT response (B) observed during treatment, and tumor response (C) and PVTT response (D) after two sessions of HAIC.

Figure 4 Overall survival (a) and intrahepatic progression-free survival (b) by Kaplan-Meyer analysis, and subgroup analysis for overall survival and intrahepatic progression-free survival considering the presence or absence of APS (c and d).

Abbreviation: APS, arterioportal shunt.
Figure 4 Overall survival (a) and intrahepatic progression-free survival (b) by Kaplan-Meyer analysis, and subgroup analysis for overall survival and intrahepatic progression-free survival considering the presence or absence of APS (c and d).

Table 4 Univariate and Multiple Analysis of Prognostic Factor for OS

Table 5 Univariate and Multiple Analysis of Prognostic Factor for InPFS

Table 6 Adverse Events