Transarterial chemoembolization in combination with lenvatinib and sintilimab for the treatment of unresectable hepatocellular carcinoma with arterioportal shunts: a retrospective analysis.

Background: The efficacy of transarterial chemoembolization (TACE) in treating unresectable hepatocellular carcinoma (uHCC) complicated by arterioportal shunts (APS) was unsatisfactory. Developed systemic therapies can synergize with TACE, potentially reducing APS recanalization and enhancing patient benefits. The objective of this study was to evaluate and compare the therapeutic efficacy and safety of a combination therapy regimen that includes TACE, lenvatinib, and sintilimab (TACE-L-S) versus TACE monotherapy in uHCC patients with APS.

Methods: After reviewing hospital records, this retrospective study enrolled 96 patients: 51 in the TACE-L-S group and 45 in the TACE group. We utilized the Chi-squared test to analyze tumor response, changes in APS grades, APS recanalization rates, and adverse events (AEs) between the two groups. Kaplan-Meier analysis was employed to compare median progression-free survival (mPFS). Cox regression analyses were conducted to identify factors influencing mPFS, whereas logistic regression analyses were performed to assess factors influencing APS recanalization rates.

Results: The objective response rate (ORR) was 68.6% in the TACE-L-S group and 37.8% in the TACE group (P=0.002). The TACE-L-S group had better mPFS compared to the TACE group (168 111 days, P<0.001), influenced by the treatment option, hepatic vein invasion, and portal vein tumor thrombosis (PVTT) type. Following the first TACE procedure, APS grades were similar between the groups; however, at 3 months after the first TACE, the TACE-L-S group demonstrated better APS grades. APS recanalization rates also differed significantly between the groups (24.4% 53.8%, P=0.006), influenced by the treatment option, preoperative APS grade, and PVTT type. AEs associated with TACE-L-S were tolerable.

Conclusions: For uHCC patients with APS, TACE-L-S may be a kind of effective and safe therapy.