Hepatic arterial infusion chemotherapy combined with transcatheter chemoembolization, camrelizumab, and apatinib for hepatocellular carcinoma with portal vein tumor thrombosis: A retrospective study.

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Background: This study evaluated the combination of hepatic arterial infusion chemotherapy (HAIC), transcatheter chemoembolization (TACE), camrelizumab, and apatinib in patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombus (PVTT). Methods: Approved by the Ethics Committee of the First Hospital of Jilin University, this retrospective study enrolled patients with: (1) HCC with PVTT; (2) treatment between December 2023 and January 2026; (3) receipt of HAIC, TACE, camrelizumab, and apatinib; (4) complete treatment and follow-up records. The primary outcome was progression-free survival (PFS). Secondary outcomes included overall survival (OS), objective response rate (ORR), disease control rate (DCR), and safety. Results: Sixty-one patients were included. Median age < 65 years: 63.9%; male: 82.0%; HBV: 62.3%; HCV: 14.8%. PVTT distribution: Vp0 (3.3%), Vp2 (16.4%), Vp3 (57.4%), Vp4 (23.0%). Extrahepatic metastases: 18.0%; tumor diameter ≥7 cm: 55.7%. Child-Pugh A: 68.9%, B: 31.1%. BCLC B/C: 16.4%/83.6%; CNLC IIb/IIIa/IIIb: 4.9%/75.4%/19.7%. Median PFS was 4.9 months (95% CI 3.2-8.4); median OS was 17.3 months (95% CI 10.8-not reached). ORR was 45.9% and DCR 52.5% (28 partial responses, 4 stable disease). Grade ≥3 laboratory abnormalities related to interventional therapy included elevated ALT, AST, anemia, and decreased white blood cell count; systemic therapy-related abnormalities included elevated ALT, AST, bilirubin, anemia, and decreased white blood cell count. No treatment-related deaths occurred. Conclusions: HAIC, TACE, camrelizumab, and apatinib showed promising efficacy and acceptable safety in HCC with PVTT. Prospective randomized trials are needed.