本研究旨在比较阿特珠单抗联合贝伐单抗（Ate/Bev）疗法与经动脉化疗栓塞联合放射治疗（TACE + RT）在未发生转移的门静脉癌栓（PVTT）肝细胞肝癌（HCC）患者的治疗结果。在2016年6月至2022年10月期间，我们连续纳入了855名PVTT患者。排除758名患者后，分析了97名患者（Ate/Bev组37例，TACE + RT组60例）。两组在基线特征上无显著差异，并且具有相似的客观缓解和疾病控制率。然而，与TACE + RT组相比，Ate/Bev组的一年生存率显著较高（p = 0.041），在HCC负担重的患者中一直如此。与此同时，在单叶内肝内HCC患者中，两组之间的临床结果相当。在Cox回归分析中，Ate/Bev治疗被证实是更好的一年生存的重要因素（p = 0.049）。最后，在倾向评分匹配中，Ate/Bev组显示出比TACE + RT组更好的一年生存（p = 0.02）和无进展生存期（p = 0.01）。总之，与TACE + RT治疗相比，Ate/Bev治疗在具有PVTT的HCC患者中显示出更好的临床结果。同时，在单叶内肝内HCC患者中，TACE + RT也可以作为Ate/Bev疗法的一种替代治疗选择。

This study aimed to compare the treatment outcomes of atezolizumab-plus-bevacizumab (Ate/Bev) therapy with those of transarterial chemoembolization plus radiotherapy (TACE + RT) in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) and without metastasis. Between June 2016 and October 2022, we consecutively enrolled 855 HCC patients with PVTT. After excluding 758 patients, 97 patients (n = 37 in the Ate/Bev group; n = 60 in the TACE + RT group) were analyzed. The two groups showed no significant differences in baseline characteristics and had similar objective response and disease control rates. However, the Ate/Bev group showed a significantly higher one-year survival rate (p = 0.041) compared to the TACE + RT group, which was constantly displayed in patients with extensive HCC burden. Meanwhile, the clinical outcomes were comparable between the two groups in patients with unilobar intrahepatic HCC. In Cox-regression analysis, Ate/Bev treatment emerged as a significant factor for better one-year survival (p = 0.049). Finally, in propensity-score matching, the Ate/Bev group demonstrated a better one-year survival (p = 0.02) and PFS (p = 0.01) than the TACE + RT group. In conclusion, Ate/Bev treatment demonstrated superior clinical outcomes compared to TACE + RT treatment in HCC patients with PVTT. Meanwhile, in patients with unilobar intrahepatic HCC, TACE + RT could also be considered as an alternative treatment option alongside Ate/Bev therapy.