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Studies on HAIC have included populations with various degrees of intrahepatic tumor burden, including the possible presence of PVT/EHS.

对HAIC的研究包括了不同程度肝内肿瘤负荷的人群，包括可能存在PVT/EHS。
 

 Studies on patients with PVT who received MKI treatment revealed that these patients had poor outcomes after treatment [20,21].

对接受MKI（多激酶抑制剂）治疗的PVT患者的研究显示，这些患者在[20,21]治疗后预后较差。
 

 By contrast, HAIC was reported to be associated with encouraging ORRs (24 to 71%) and OS (7.1 to 30.4 months) in this group of patients (Table 1).

相比之下，据报道，HAIC与令人鼓舞的ORRs（24至71%）和OS(71到30.4月），这组患者（表）。

表：Selected studies on HAIC versus sorafenib as the first-line treatment for advanced HCC.

作者	研究类型	病例数	Regimen	CP-B	HBV	PVT	EHS	ORR	OS	p值
Song et al. [28]	Retrospective PVT	50	Cisplatin 60 mg/m2, Day 2 5-FU 500 mg/m2, Days 1–3 +/− Epirubicin 35 mg/m2, Day 1 (every 3–4 weeks)	10.0	88.0	100	13.0	24.0	7.1	0.011
		60	索拉非尼	21.7	68.3	100	35.0	13.3	5.5
Hatooka et al. [27]	Retrospective Refractory to TACE	65	Cisplatin 6 mg/m2, Days 1–5, 8–12 5-FU 300 mg/m2, Days 1–5, 8–12 * (every 4 weeks)	0	23.1	35.4 (Vp3–4)	0	12.0	8.0	0.021
		58	索拉非尼	0	22.4	10.3 (Vp3–4)	0	6.0	15.0
Moriguchi et al. [22]	Retrospective Vp3–4	32	Cisplatin 10 mg/m2, Day 1; 5-FU 250 mg/m2, Days 1–5 (weekly for 4 weeks, then only Day 1 per week)	0	37.5	100	21.9	31.3	10.3	0.009
		14	索拉非尼	0	28.6	100	35.7	0	4.0
Nakano et al. [23]	Retrospective With MVI, without EH	44	Cisplatin 50 mg/m2 in 5–10 mL lipiodol, Day 1 5-FU 1500 mg/m2 for 5 day for 2 weeks then cisplatin 25–30 mg/m2 + 5FU 500–1000 mg/m2 (ever 2 weeks)	0	14.0	100	0	71.0	30.4	＜0.001
		20	索拉非尼	0	25.0	100	0	10.0	13.2
Kodama et al. [25]	Retrospective No EHS	150	Cisplatin 6 mg/m2, Days 1–5, 8–12 5-FU 300 mg/m2, Days 1–5, 8–12 (every 4 weeks)	0	25.3	73.3	0	32.0	10.0	0.007
		134	索拉非尼	0	16.4	29.1	0	4.0	19.0
Lyu et al. [24]	Retrospective HAIC for patients who refused sorafenib	180	mFOLFOX 6 (HAIC) (every 3 weeks)	0	86.7	54.4	60	29.4	14.5	<0.001
		232	索拉非尼	0	80.2	55.6	58.6	3.0	7.0
Kondo et al. [26]	Randomized Phase 2 (CP-A to B7)	35	Cisplatin 65 mg/m2, Day 1 (every 4–6 weeks)	11.4	8.6	60.0	28.6	14.3	10.0	0.780
		33	索拉非尼	12.1	12.1	66.7	24.2	9.1	15.2
Ahn et al. [38]	Retrospective VP4	38	Cisplatin 60 mg/m2, Day 1 5-FU 500 mg/m2, Days 1–3	29.0	86.6	100	5.3	5.2	10	0.150
		35	索拉非尼	31.0	69.0	100	46	0	6.4
Ueshima et al. [37]	Retrospective Cohort 1 with MVI, Without EHS	270	Cisplatin + 5FU or 5-FU or cisplatin (detail of regimens were not reported)	36.9	23.0	100	0	NR	10.6	0.475
		263	索拉非尼	16.0	21.3	100	0	NR	9.1
Zaizen et al. [41]	Retrospective Propensity score-matched	83	Cisplatin 65 mg/m2, Day 1 (every 8–12 weeks)	36.1	7.2	14 (MVI)	0	NR	15.6	0.016
		83	索拉非尼	28.9	8.4	11(MVI)	0	NR	11.0
Lyu et al. [35]	Randomized Phase 3	130	mFOLFOX 6 (HAIC) every 3 weeks	NR	NR	NR	NR	NR	13.9	<0.001
		132	索拉非尼	NR	NR	NR	NR	NR	8.2

aHCC: advanced hepatocellular carcinoma; CP: Child–Pugh classification; EHS: extrahepatic spread; HAIC: hepatic arterial infusion chemotherapy; HBV: hepatitis B virus; IFN-α: interferon-alpha; MVI: macrovascular invasion; NR: not reported; ORR: overall response rate; OS: overall survival; PVT: portal vein thrombosis; TACE: transcatheter arterial chemoembolization; VP3: right/left portal vein; VP4: main portal vein; 5-FU: 5-fluorouracil. * 57% patients received 5-FU plus IFNα.

 

Moreover, some studies have focused on patient subgroups with major PVT (Vp3/Vp4), and HAIC, applied alone or in combination with other treatment modalities, still demonstrated considerable efficacy and safety [22,38,53].

此外，一些研究关注于主要PVT(Vp3/Vp4)的患者亚组，而HAIC，单独使用或与其他治疗方式联合使用，仍然显示 [22,38,53].具有相当大的有效性和安全性。

 He et al. [47] recently revealed that HAIC plus sorafenib provided superior outcomes than did sorafenib in patients with HCC with PVT.

他等人[47]最近发现，HAIC加索拉非尼在HCC合并PVT患者中的预后优于索拉非尼。
 

 By contrast, the SILIUS study which tested a similar combination strategy, enrolled a more heterogeneous group of patients and only 59.5% of whom had PVT.

相比之下，SILIUS研究测试了类似的组合策略，纳入了更异质性的患者组，其中只有59人.5%患有PVT。
 

The inconsistency between the study results may partly be due to differences in patient populations.

研究结果之间的不一致性可能部分是由于患者群体的差异。
 

 The importance of patient selection is further emphasized by the FOHAIC study, which reported that HAIC monotherapy yielded superior OS than did sorafenib in patients with MVI or large intrahepatic tumor burdens [35].

FOHAIC研究进一步强调了患者选择的重要性，该研究报道，在MVI或大肝内肿瘤负担[35]患者中，HAIC单药治疗产生的OS优于索拉非尼。
 

The presence of EHS would affect HAIC outcomes.
EHS的存在会影响HAIC的结果。
 

 Because HAIC has less therapeutic efficacy to extrahepatic tumors, it is suitable only for patients with limited or indolent EHS.

由于HAIC对肝外肿瘤的疗效较差，仅适用于有限或惰性EHS患者。
 

 Ueshima et al. [37] conducted a nationwide registry study in Japan by comparing HAIC with sorafenib in 2004（原文为2006例） patients.

Ueshima等人, [37]在日本进行了一项全国性注册研究，比较了2004例的HAIC和索拉非尼

。

 Their subgroup analysis revealed that patients with MVI and without EHS who received HAIC had a significantly longer OS compared with those who received treatment of sorafenib.

他们的亚组分析显示，与接受索拉非尼治疗的患者相比，接受HAIC治疗的MVI患者的OS明显延长。
 

 By contrast, patients with EHS and without MVI who received sorafenib treatment had longer OS than did those who received HAIC.

相比之下，接受索拉非尼治疗的EHS患者和非MVI患者比接受HAIC治疗的患者OS更长。
 

Previous TACE is another factor that may sabotage HAIC efficacy.

先前的TACE是另一个可能破坏HAIC疗效的因素。
 

 This embolization would compromise original hepatic arterial supply to HCC tumors, and promote blood supply from the portal vein or extrahepatic collateral arteries [64], thus potentially attenuating response to HAIC treatment.

这种栓塞会损害对HCC肿瘤的原始肝动脉供应，并促进来自门静脉或肝外侧支动脉[64]的血供，从而可能减弱对HAIC治疗的反应。
 

 Hatooka et al.[27] retrospectively compared HAIC and sorafenib treatment in a more specific population of patients with CP-A but without EHS who were refractory to TACE.

Hatooka等人[27]回顾性比较了HAIC和索拉非尼在TACE无效的CP-A人群中的治疗。

 

 Their results showed favorable OS in the sorafenib group.

他们的结果显示索拉非尼组有良好的OS。
 

 In summary, HAIC may confer the greatest benefit in patients who have PVT or a large hepatic tumor burden, who with no or limited EHS, and who are not refractory to TACE.

总之，HAIC可能对PVT或大肝肿瘤负担、无或EHS有限、对TACE不难治的患者提供最大的益处。