TIPS Combined With Lenvatinib and PD-1 Inhibitor for Advanced HCC With Main Trunk PVTT

Inclusion Criteria:

1. diagnosis of primary HCC, confirmed histologically or clinically according to thecriteria of the American Association for the Study of Liver Diseases;

2. presence of PVTT with III-IV grade by Cheng's criteria;

3. having PVTT induced portal hypertension;

4. with or without PVTT induced acute variceal bleeding;

5. metastases with limited five sites and no more two organs involved;

6. Number of Intrahepatic tumors were no more than five;

7. receipt of Lenvatinib and PD-1 inhibitor as the first-line systemic therapy;

8. classified as Child-Pugh class A or B and having an Eastern Cooperative OncologyGroup (ECOG) performance status of 0 or 2;

9. no history of other malignancies;

10. agreed to participated in this clinical trial;

11. Hemameba ≥3.0 x109/L, neutrophil ≥1.5x109/L, hemoglobin≥10.0 g/L, platelet≥100x 109/L, ALT; AST; bilirubin ≤1.5-fold normal, GFR≥60ml/min.

Exclusion Criteria:

1. recurrent HCC;

2. PVTT at I-II grade by Cheng's criteria;

3. age < 18 years or > 75 years;

4. advanced HCC with more than five metastases;

5. Number of Intrahepatic tumors were more than five;

6. no response to Lenvatinib;

7. life expectancy less than 3 months.