The selection of adjuvant therapies for advanced hepatocellular carcinoma (HCC) has been a subject of considerable interest. This study aims to investigate the potential value of Traditional Chinese Medicine (TCM) in improving outcomes for HCC patients with portal vein tumor thrombus (PVTT), and to compare the efficacy differences between approved proprietary Chinese patent medicines for HCC and the hospital-prepared formulation, Yangyin Fuzheng Jiedu Formula (YFJP).

A retrospective analysis was conducted on 892 HCC patients with PVTT treated between 2012 and 2022. Based on the actual treatments received, the cohort was divided into a Western medicine (WM) group (n=579) and an Integrated Chinese and Western Medicine (ICWM) group (n=313). The WM group received treatments recommended by the 2019 "Standard for Diagnosis and Treatment of Primary Liver Cancer," including antitumor therapy, antiviral therapy, anti-inflammatory liver protection, complication management, and supportive care. The ICWM group received the same comprehensive WM treatments plus either the modified YFJP decoction or related Chinese patent medicines (CPMs, including Ganfule Capsule, Jinlong Capsule, Kanglixin Capsule, Fufang Banmao Capsule, and Huaier Granule). Data on TCM usage duration were extracted from electronic medical records. Propensity score matching (PSM) at a 1:1 ratio and four types of propensity score weighting—Inverse Probability of Treatment Weighting (IPTW), Stabilized IPTW (sIPTW), Overlap Weighting (OW), and Standardized Mortality Ratio Weighting (SMRW)—were employed to adjust for confounding factors. Multivariable Cox proportional hazards models were used to identify independent factors influencing 5-year overall survival (OS). Forest plots were generated to display hazard differences for 5-year OS between WM and ICWM treatments across various prognostic indicators and classical model subgroups, and to identify subpopulations most likely to benefit from TCM. Kaplan-Meier survival curves were plotted to compare survival among different TCM usage patterns, durations, and types. Subpopulation Treatment Effect Pattern Plot (STEPP) analysis was utilized to identify subgroups deriving greater benefit from specific TCM formulations.

After adjustment using propensity score methods, TCM therapy was identified as an independent protective factor for prognosis in PVTT patients (adjusted HR [95% CI]: 0.4438 [0.3674, 0.5361], p < 0.001). Other independent factors influencing 5-year OS included etiology, WM treatment modality, platelet count, creatinine level, gamma-glutamyl transferase level, alpha-fetoprotein level, mean platelet volume, and CD8+ T-cell count. Prolonged duration of TCM administration was associated with a stronger protective effect on prognosis (p for trend < 0.001), indicating greater patient benefit. STEPP analysis revealed that patients with mild to moderate thrombocytopenia, prothrombin activity approaching 70%, or an inflammatory burden index greater than 4 derived significantly more benefit from the YFJP decoction than from CPMs (p < 0.05).

 Long-term adjunctive therapy with TCM can significantly improve the prognosis of HCC patients with PVTT. The effectiveness of Chinese patent medicines was reaffirmed. Subgroups with relatively better coagulation function or more severe inflammation were more likely to benefit from the YFJP decoction, suggesting potential targets for future mechanistic research.