Hepatic Arterial Infusion Chemotherapy in the Treatment of Unresectable Hepatocellular Carcinoma with or Without Extrahepatic Spread: A Propensity Score Matching Study

Purpose: To study the efficacy and safety of hepatic artery infusion chemotherapy (HAIC) in the treatment of unresectable hepatocellular carcinoma (HCC) with extrahepatic spread (EHS). Materials and Methods: 323 patients with unresectable HCC received HAIC plus lipiodol microvascular embolization. Treatment responses were evaluated based on mRECIST criteria. The objective response rate (ORR), progression free survival (PFS) and overall survival (OS) of patients with EHS were compared to those without. Subgroup analyses of patients with or without major portal vein tumor thrombosis (PVTT) were performed both before and after propensity score matching (PSM). The survival analysis was calculated with Kaplan-Meier method and compared using the log-rank test. All the statistical analyses were performed by SPSS (version 26.0). Result: The overall ORR was 59.1%.The median OS of the initial all cohort and patients with positive and negative EHS were 16.3, 12.0 and 18.0 months, respectively (p=0.002). In the subgroup analysis, there was no statistical difference of survival in patients with major PVTT between the with-EHS and without-EHS groups (13.0 vs 15.0 months, p=0.407). However, the median OS in patients with EHS was significantly shorter than those without EHS (11.4 vs 19.4 months, p<0.001) in the subgroup of non-major PVTT patients. After PSM, there were no significant survival differences between the EHS and non-EHS groups in any patient cohort or sub-cohort analysis. Conclusion: For unresectable HCC, controlling intrahepatic tumors through HAIC is more important than controlling extrahepatic tumors, especially in patients with major PVTT. Locoregional HAIC can be performed in patients with EHS.