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.