探讨肝动脉灌注化疗（hepatic arterial infusion chemotherapy, HAIC）联合门静脉腔内照射支架在原发性肝癌合并门静脉癌栓（portal vein tumor thrombus, PVTT）Ⅲ型患者中的临床疗效及安全性。

回顾性分析2021年1月至2024年12月在新疆医科大学第一附属医院接受治疗的30例肝细胞癌（hepatocellular carcinoma, HCC）合并PVTT Ⅲ型患者，按照治疗方案分为观察组（HAIC联合门静脉腔内照射支架，15例）和对照组（单纯HAIC，15例）。比较2组疗效、肝功能变化、不良反应、生存期等指标。

观察组疾病控制率（disease control rate, DCR）为86.7%（13/15），显著高于对照组66.7%（10/15），差异有统计学意义（P=0.031）。中位无进展生存（progression-free survival, PFS）时间：观察组17.6个月（95% CI：14.8~20.4）vs.对照组5.6个月（95% CI：4.7~6.5），log-rank P<0.001；中位总生存（overall survival, OS）时间：观察组18.1个月（95% CI：15.2~21.0）vs.对照组5.9个月（95% CI：5.1~6.9），log-rank P<0.001。因素Cox回归显示，治疗方案为OS独立预后因素（HR 0.28，95% CI：0.10~0.75，P=0.011）。术后总胆红素水平以中位数：观察组23.87±9.03 μmol/L，显著低于对照组45.94±24.46 μmol/L(P=0.015）；术后ALBI 2级比例93.3% vs. 46.7%（P=0.014）。不良事件多为Ⅰ–Ⅱ级，观察组与对照组总体发生率无差异（26.7% vs. 20.0%，P=0.648）。

HAIC联合门静脉腔内照射支架显著提高PVTT Ⅲ型肝癌患者病灶控制率与生存期，改善肝功能且安全性良好。

To evaluate the clinical efficacy and safety of hepatic arterial infusion chemotherapy (HAIC) combined with portal vein endovascular brachytherapy stent implantation in patients with primary hepatocellular carcinoma (HCC) complicated by type Ⅲ portal vein tumor thrombus (PVTT).

We retrospectively analyzed 30 patients with type Ⅲ PVTT treated at the First Affiliated Hospital of Xinjiang Medical University between January 2021 and December 2024. Patients were assigned to an observation group (HAIC + portal vein endovascular brachytherapy stent, n=15) or a control group (HAIC alone, n=15). Treatment efficacy, liver function parameters, adverse events, progression-free survival (PFS), and overall survival (OS) were compared.

The disease control rate (DCR) was higher in the observation group than in the control group (86.7% [13/15] vs. 66.7% [10/15], P=0.031). Median PFS was significantly prolonged in the observation group (17.6 months, 95% CI: 14.8~20.4) compared with the control group (5.6 months, 95% CI: 4.7~6.5; log-rank P<0.001). Median OS was also longer in the observation group (18.1 months, 95% CI: 15.2~21.0) versus the control group (5.9 months, 95% CI: 5.1~6.9; log-rank P<0.001). Liver function recovery was better in the observation group, with lower post-treatment total bilirubin levels (23.87 ± 9.03 μmol/L vs. 45.94±24.46 μmol/L, P=0.015) and a higher proportion of patients maintaining ALBI grade 2 (93.3% vs. 46.7%, P=0.014). Most adverse events were grade I–II, and the overall incidence was similar between groups (26.7% vs. 20.0%, P=0.648). Cox regression analysis identified treatment group as an independent predictor of OS (HR 0.28, 95% CI: 0.10~0.75, P=0.011).

HAIC combined with portal vein endovascular brachytherapy stent implantation significantly improves disease control, liver function recovery, and survival compared to HAIC alone in PVTT type III HCC patients, with a favorable safety profile.