Survival benefits of non-surgical triple therapy in hepatocellular carcinoma with inferior vena cava/right atrial tumor thrombus: A retrospective analysis from a multidisciplinary team.

Hepatocellular carcinoma (HCC) with inferior vena cava and/or right atrial tumor thrombus (IVC/RA TT) is associated with extremely poor prognosis, and the optimal non-surgical treatment approach remains unclear. The current retrospective cohort study aimed to evaluate the efficacy of multidisciplinary team (MDT)-guided non-surgical management in 41 patients with HCC and IVC/RA TT treated at West China Hospital (Sichuan University, Chengdu, China) between January 2019 and December 2023. Patients were categorized according to treatment modality into the following four groups: Systemic therapy alone (n=8), mono-locoregional therapy (n=4), dual-modality therapy (n=14) and triple-modality therapy consisting of systemic therapy, stereotactic body radiation therapy and transarterial chemoembolization (n=15). The triple-modality group displayed significantly longer median overall survival (15 months) and progression-free survival (7 months) compared with the other treatment groups (P=0.019 and P=0.03, respectively). Multivariable Cox regression analysis identified triple-modality therapy as a significant independent protective factor for survival. In addition, this regimen exhibited a favorable safety profile, with no grade ≥3 treatment-related adverse events observed. These preliminary findings suggest that MDT-guided triple-modality combination therapy represents a feasible, safe, and well-tolerated strategy that might offer survival benefits for this high-risk population, although further large-scale validation is necessary.