Diagn Interv Imaging. 2026;107(1):25-37.
Transarterial radioembolization versus atezolizumab-bevacizumab for the treatment of hepatocellular carcinoma with portal vein tumor thrombosis.
제1저자 박영수,조유리,김승업,김아영 · 교신저자 김윤준
소속 (11)
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 03080 Seoul, Republic of Korea; Center for Liver and Pancreatobiliary Cancer, National Cancer Center, 10408 Goyang, Republic of Korea.
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, 10408 Goyang, Republic of Korea.
- Department of Internal Medicine and Yonsei Liver Center, Severance Hospital, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea.
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06351 Seoul, Republic of Korea; Department of Internal Medicine, Inje University Ilsan Paik Hospital, 10380 Goyang, Republic of Korea.
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 03080 Seoul, Republic of Korea.
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 03080 Seoul, Republic of Korea.
- Department of Radiology, National Cancer Center, 10408 Goyang, Republic of Korea.
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, 03722 Seoul, Republic of Korea.
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06351 Seoul, Republic of Korea.
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 06351 Seoul, Republic of Korea.
- Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 03080 Seoul, Republic of Korea. Electronic address: yoonjun@snu.ac.kr.
Abstract
PURPOSE The purpose of this study was to compare transarterial radioembolization (TARE) and atezolizumab plus bevacizumab (Atezo/Bev) in treatment-naïve patients with hepatocellular carcinoma (HCC) and portal vein tumor thrombosis (PVTT) without extrahepatic metastasis.
MATERIAL AND METHODS This multicenter retrospective study evaluated 213 patients initially treated with TARE or Atezo/Bev between 2016 and 2023. The primary outcome was overall survival, and the secondary outcomes were progression-free survival, objective response rate, and safety. Baseline characteristics were adjusted using inverse probability treatment weighting or propensity score matching.
RESULTS Deaths occurred in 36 out of 125 patients (28.8 %) in the TARE group and 57 out of 88 patients (64.8 %) in the Atezo/Bev group. The median overall survival was significantly longer in the TARE group (27.5 months) than in the Atezo/Bev group (8.6 months) (P < 0.01), consistent across analyses before matching (hazard ratio [HR], 0.38; 95% confidence interval [CI]: 0.25-0.58; P < 0.01), after inverse probability treatment weighting (HR, 0.49; 95 % CI: 0.28-0.85; P = 0.01), and after propensity score matching (HR, 0.40; 95% CI: 0.22-0.74; P < 0.01). In the PVTT subgroup involving segmental to lobar branches (Vp1-3), TARE demonstrated prolonged overall survival (HR, 0.36; 95 % CI: 0.20-0.63; P < 0.01), with no significant difference in patients with Vp4. The TARE and Atezo/Bev groups exhibited similar progression-free survival. No significant differences in objective response rate were found between TARE group (22.2-30.9 %) and Atezo/Bev group (30.6-30.9 %). Adverse events were less frequent in the TARE group than in the Atezo/Bev group. The incidence of grade ≥ 2 ascites and variceal bleeding were significantly lower in the TARE group (12.0 % and 1.7 %, respectively) than in the Atezo/Bev group (20.5 % and 8 %, respectively) (both P < 0.05). No significant differences in Child-Pugh score aggravation of ≥ 2 were observed between the TARE group (14.4 %) and the Atezo/Bev group (25 %) (P = 0.08).
CONCLUSION For patients with preserved liver function and locally advanced HCC involving segmental or lobar PVTT, TARE may be preferable to Atezo/Bev.
Copyright © 2025. Published by Elsevier Masson SAS.
Keywords
AtezolizumabBevacizumab, Hepatocellular carcinomaPortal vein tumor thrombosisTransarterial radioembolization
Conflict of interest statement
Declaration of competing interest Dr. Seung Up Kim has served as an advisory committee member Gilead Sciences, Bayer, Eisai, and Novo Nordisk. He is a speaker for Gilead Sciences, GSK, Bayer, Eisai, Abbive, EchoSens, MSD, Eisai, Otsuka, and Bristol-Myers Squibb. He reports receiving research grants from Abbive, Bristol-Myers Squibb, and Gilead. Dr. Yun Bin Lee reports receiving research grants from Samjin Pharmaceuticals and Yuhan Pharmaceuticals; Dr. Jeong-Hoon Lee reports receiving research grants from Yuhan Pharmaceuticals, and lecture fees from GreenCross Cell, Daewoong Pharmaceuticals, and Gilead Korea; Dr. Su Jong Yu reports receiving research grants from Yuhan Pharmaceuticals and Daewoong Pharmaceuticals; Dr. Jung-Hwan Yoon reports receiving research grants from Dicerna Pharmaceuticals, Roche, GlaxoSmithKline, AstraZeneca, Daewoong Pharmaceuticals, and Hanmi Pharmaceuticals; Dr. Yoon Jun Kim reports receiving research grants from BTG, Boston Scientific, AstraZeneca, Gilead Sciences, Samjin, BL&H, and Bayer, and lecture fees from Roche, Abbvie, Eisai, Boston Scientific, BMS, BTG, Bayer, MSD, Novo Nordisk, Green Cross Cell, Boehringer Ingelheim, and Gilead. The authors have no conflict of interest to disclose in relation with this article.
그 밖의 정보
- 출판 형태
- Journal Article, Multicenter Study, Comparative Study
- 저널
- Diagnostic and interventional imaging · eISSN 2211-5684
- 전자 출판
- 2025-09-24
- MeSH
- Humans · Carcinoma, Hepatocellular* / therapy / complications / mortality · Liver Neoplasms* / therapy / complications / mortality · Male · Female · Bevacizumab* / therapeutic use / administration & dosage · Retrospective Studies · Portal Vein* · Antibodies, Monoclonal, Humanized* / therapeutic use / administration & dosage · Middle Aged · Aged · Embolization, Therapeutic* / methods · Venous Thrombosis* / therapy / etiology · Antineoplastic Agents, Immunological / therapeutic use
- Substances
- Bevacizumab · Antibodies, Monoclonal, Humanized · atezolizumab · Antineoplastic Agents, Immunological