Hepatic Arterial Infusion Chemotherapy of RALOX Versus FOLFOX, Combined With Radiotherapy, Targeted Therapy, and Immunotherapy for Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Multi‐Center Retrospective Study

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The combination of hepatic arterial infusion chemotherapy (HAIC) with radiotherapy, tyrosine kinase inhibitors (TKIs), and immune checkpoint inhibitors (ICIs) has shown promise for hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). However, the optimal HAIC regimen remains unclear. This multicenter retrospective study compared the safety and effectiveness of raltitrexed plus oxaliplatin (RALOX‐HAIC) versus the FOLFOX regimen in this setting. From January 2020 to June 2023, 38 HCC patients with PVTT treated at two Chinese centers were enrolled: 19 received RALOX‐HAIC and 19 received FOLFOX‐HAIC, all with concurrent radiotherapy, TKIs, and ICIs. Baseline differences were balanced using inverse probability weighting. Outcomes included tumor response, postoperative hospital stay, adverse events, progression‐free survival (PFS), and overall survival (OS). Cox regression and weighted analyses were performed. The objective response rate (78.9% vs 73.7%) and disease control rate were similar between groups. Median postoperative hospital stay was significantly shorter with RALOX‐HAIC (3 vs. 5 days, p < 0.001). Adverse event rates did not differ. Unadjusted PFS and OS showed no significant differences (HR = 0.742, p = 0.388; HR = 0.771, p = 0.489). However, after adjusting for age, body mass index, and PVTT classification, the RALOX‐HAIC group had significantly better OS (HR = 0.314, p = 0.037). PFS remained comparable after adjustment (HR = 0.590, p = 0.239). Compared with FOLFOX‐HAIC, the RALOX‐HAIC combination significantly shortens postoperative hospital stay and, after adjustment for confounders, improves OS without increasing adverse events. RALOX‐HAIC is a promising alternative for HCC patients with PVTT.

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