TACE–HAIC combined with apatinib and camrelizumab for unresectable hepatocellular carcinoma with portal vein tumor thrombus: a multicenter retrospective study

Background and objectives Unresectable hepatocellular carcinoma (uHCC) with portal vein tumor thrombus (PVTT) indicates a poor prognosis. This study aims to evaluate the efficacy and safety of transarterial chemoembolization (TACE) combined with hepatic arterial infusion chemotherapy (HAIC), apatinib, and camrelizumab in patients with uHCC accompanied by PVTT. Methods This multicenter retrospective study included patients with uHCC and PVTT who were treated at five tertiary medical centers in China between December 2021 and April 2025. Propensity score matching (PSM) was performed to minimize potential confounding bias. Treatment efficacy was assessed by objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). The primary endpoints were PFS and OS, whereas secondary endpoints included ORR and safety. Results Among the 222 patients who met the eligibility criteria, 105 received TACE-HAIC combined with apatinib and camrelizumab (THAC group), and 117 received TACE combined with apatinib and camrelizumab (TAC group). After PSM, 86 matched patients were included in each group, and baseline characteristics were well balanced between the two groups. The THAC group achieved significantly higher intrahepatic tumor ORR (70.9% vs. 47.7%, P = 0.002) and DCR (94.2% vs. 79.1%, P = 0.004) than the TAC group. Similarly, for PVTT, the THAC group demonstrated significantly higher ORR (61.6% vs. 41.9%, P = 0.009) and DCR (90.7% vs. 74.4%, P = 0.005). The median PFS was significantly longer in the THAC group than in the TAC group (12 months vs. 7 months; HR = 0.287; 95%CI: 0.204–0.403; P<0.001). Likewise, the median OS was significantly prolonged in the THAC group (24 months vs. 16 months; HR = 0.198; 95%CI: 0.135–0.291; P<0.001). The incidence of adverse events did not differ significantly between the two groups (P>0.05). All adverse events were manageable, and no grade 5 adverse events were observed. Conclusions In patients with uHCC accompanied by PVTT, the THAC regimen was associated with superior survival outcomes compared with the TAC regimen while maintaining an acceptable safety profile. These findings suggest that THAC may represent a feasible and effective therapeutic option for this patient population.