Gamma Knife Radiosurgery Versus Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: a Propensity Score Matching Study

Abstract

Abstract BackgroundThe optimal management for hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) is unclear. This study aimed to investigate the efficacy of Gamma knife radiosurgery (GKR) versus transcatheter arterial chemoembolization (TACE) in HCC patients with PVTT. MethodsThis retrospective study included 572 HCC patients with PVTT (GKR, 207; TACE, 365). Propensity score matching (PSM) analysis identified 188 matched pairs of patients. The primary endpoint was overall survival (OS).ResultsBefore PSM, the GKR group demonstrated significantly median OS (mOS) than TACE group (17.4 vs. 8.0 months, p < 0.001). In the subgroup analysis, GKR was associated with significantly longer OS for patients with PVTT II-IV (17.5 vs. 8.2 months, p < 0.001; 19.3 vs. 7.4 months, p < 0.001; 14.5 vs. 6.6 months, p = 0.008, respectively) and comparable OS for patients with PVTT I. After PSM, the GKR group had also a longer OS (mOS) than TACE group (15.8 vs. 9.8 months, p < 0.001). In the subgroup analysis, the GKR group demonstrated superior mOS for patients with PVTT II-IV (all P < 0.05) and comparable OS for patients with PVTT I. ConclusionsGKR was associated better OS than TACE in HCC patients with PVTT, especially for patients with PVTT II-IV.