Abstract
BACKGROUND: Increasing evidence indicates that psychological factors play a role in tumor progression. This study aims to explore the impact of anxiety disorder on the prognosis of hepatocellular carcinoma (HCC) patients with portal vein tumor thrombus (PVTT) who underwent hepatic arterial infusion chemotherapy (HAIC). METHODS: A propensity score-matching cohort study was conducted in 68 HCC patients with PVTT who underwent HAIC between January 2020 and December 2023. The anxiety situation was evaluated using the Hamilton Anxiety Rating Scale before HAIC. The objective response rate, overall survival (OS), progression-free survival, and adverse events were compared between the different anxiety score groups. Using Cox proportional hazards models for univariate and multivariate analysis to explore the risk factors of OS. RESULTS: No statistical difference was found in the tumor response, treatment-related adverse events, and PFS between the two groups before and after PSM. Compared with low anxiety scores patients, the OS of obvious anxiety patients was shorter (hazard ratio [HR] = 1.606; 95%CI: 0.868-2.973; P = 0.116). The univariate and multivariate analysis showed that BMI (HR = 1.174, 95%CI: 1.044-1.320; P = 0.007), high anxiety score (HR = 2.769, 95%CI: 1.289-5.947; P = 0.007), and serum ammonia (HR = 1.059; 95%CI: 1.032-1.086; P < 0.001) were independent risk factors of OS. CONCLUSIONS: Our study reveals that elevated anxiety scores in HCC patients with PVTT correlated with poor prognosis, indicating that it's a potential prognostic marker. The high anxiety score, BMI, and serum ammonia were independent risk factors of OS.