Should transarterial chemoembolization be applied with systemic therapy for hepatocellular carcinoma with hepatic vein and/or inferior vena cava tumor thrombus (CHANCE2505)?: A multicenter study
Bibliographic record
Abstract
BACKGROUND: Systemic therapy with or without radiotherapy is useful for hepatocellular carcinoma (HCC) with hepatic vein and/or inferior vena cava tumor thrombus (HVTT/IVCTT). However, the efficacy of transarterial chemoembolization (TACE) in such population is still unconfirmed. This study aims to evaluate whether TACE should be applied with systemic therapy for HCC with HVTT/IVCTT, in a first-line therapy setting. METHODS: This multi-center retrospective cohort study included HCC patients with HVTT/IVCTT treated between June 2018 and March 2024. Patients received either systemic therapy plus TACE (Group A) or systemic therapy alone (Group B). Propensity score matching (PSM) was utilized to balance the baseline characteristics. Multiple sensitivity analysis including inverse probability of treatment weighting (IPTW) were performed. The primary outcomes were overall survival (OS) and progression-free survival (PFS). Secondary outcomes included objective response rate (ORR) and safety. RESULTS: A total of 972 HCC patients with HVTT/IVCTT (696 in Group A and 276 in Group B) were included. The median follow-up time was 32.1 (95% CI: 30.4-33.8) months. After PSM, Group A demonstrated a significantly longer median OS compared to Group B (20.9 vs. 14.3 months; HR = 0.65, 95% CI: 0.54-0.77, P<0.001). Group A achieved a significantly longer median PFS compared to Group B (10.7 vs. 7.3 months; HR = 0.67, 95% CI: 0.57-0.79, P<0.001, per RECIST v1.1 criteria). Additionally, Group A exhibited a significantly higher objective response rate per RECIST v1.1 (45.3% vs. 28.8%, P<0.001) and mRECIST criteria (53.6% vs. 36.3%, P<0.001). Grade ≥3 treatment-related adverse events occurred in 238 patients in Group A (34.2%) and 87 patients in Group B (31.5%). CONCLUSIONS: TACE in combination with systemic therapy shows improved survival benefit and manageable safety profiles compared to systemic therapy alone for HCC patients with HVTT/IVCTT. These findings provide preliminary evidence supporting the integration of TACE into first-line systemic therapy for this patient population. However, given the retrospective nature of this study, validation through prospective randomized controlled trials is warranted.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".