Comparative outcomes of systemic therapy vs. locoregional therapies in hepatocellular carcinoma with portal vein thrombosis.

e16317 Background: Portal vein thrombosis (PVT) in hepatocellular carcinoma (HCC) presents a significant challenge, with treatment options including locoregional therapies and systemic therapies. This study evaluates the outcomes of these treatments in HCC patients with PVT. Methods: A retrospective cohort study was conducted using the TriNetX database from 2010 to 2020. A total of 268 patients with HCC and PVT were included. After matching, 134 patients received locoregional therapies (TACE or TARE), and 134 received systemic therapy (sorafenib and Lenvatinib). Results: After matching, the Locoregional Therapy cohort included 134 patients with a mean age of 71.2 ± 8.1 years, and 63.6% were male. Ethnicity distribution was 55.3% not Hispanic or Latino (n = 74), 52.8% White (n = 78), and 9.7% Black (n = 13). The Systemic Therapy cohort included 134 patients with a mean age of 70.8 ± 8.5 years, and 62.7% were male. Ethnicity distribution in this group was 57.5% not Hispanic or Latino (n = 77), 47.8% White (n = 64), and 15.0% Black (n = 20). Over a follow-up period exceeding 5 years, the median follow-up was shorter in the Systemic Therapy group (255 days; IQR: 460 days) compared to the Locoregional Therapies group (1,029.5 days; IQR: 1,488 days). Median survival probabilities at the end of follow-up were significantly lower in the Systemic Therapy group (22.794%) compared to the Locoregional Therapies group (54.491%), with a hazard ratio of 0.3 (95% CI: 0.209–0.431; p = 0.0002). Secondary outcomes analysis revealed that Locoregional Therapies were associated with increased risks of gastrointestinal bleeding (HR: 1.183, 95% CI: 0.596–2.349, p = 0.0189) and acute hepatic failure (HR: 1.496, 95% CI: 0.891–2.514, p = 0.0141). However, they were linked to a reduced risk of hepatic encephalopathy (HR: 0.554, 95% CI: 0.278–1.104, p = 0.0386) compared to Systemic Therapy. Conclusions: Locoregional Therapies demonstrated longer follow-up and improved survival but increased risks of GI bleeding and hepatic failure, while reducing hepatic encephalopathy risk compared to Systemic Therapy over 5 years.