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High conversion and survival benefits of transarterial chemoembolization plus targeted immunotherapy in initially unresectable hepatocellular carcinoma: efficacy, safety, and optimal patient selection

Year: 2025

Type: article

Abstract: INTRODUCTION: Primary liver cancer ranks among the most prevalent malignancies globally. AIM We aimed to evaluate the efficacy and safety of transarterial chemoembolization (TACE) combined with targeted immunotherapy in initially unresectable hepatocellular carcinoma (uHCC), and identify patients most likely to benefit from this approach. MATERIALS AND METHODS: We retrospectively analyzed 68 uHCC patients treated with TACE with targeted immunotherapy at the Nanjing Drum Tower Hospital (April 2020-July 2024). Tumor response was assessed using the modified Response Evaluation Criteria in Solid Tumors. Progression‑free survival (PFS) and overall survival rates were estimated with the Kaplan-Meier analysis. Logistic and Cox regression models were used to identify the predictors of response and survival. RESULTS: The objective response rate was 57.4%, and the disease control rate amounted to 89.7%. Median PFS was 13.8 months (95% CI, 8.7-19), with 6- and 12‑month PFS rates of 73.1% and 52.5%, respectively. Surgical conversion occurred in 52.9% of the patients, with 94.6% achieving R0 resection; 47.2% had ma‑ jor pathologic response. Multivariable analysis showed that fewer than 3 tumors (hazard ratio [HR], 6.35; P = 0.01) and absence of major vascular invasion (HR, 3.89; P = 0.03) independently predicted favorable response, while the male sex (HR, 0.27; P <0.001), China Liver Cancer (CNLC) stage Ib-IIa (HR, 6.05; P <0.001), and proton density fat fraction (PDFF) below 6.5% (P = 0.03) predicted longer PFS. Grade 3 adverse events occurred in 52.9% of the patients, with no grade 4-5 events. All were manageable. CONCLUSIONS: TACE with targeted immunotherapy yields high response and surgical conversion rates with acceptable toxicity in uHCC. Patients with CNLC stage Ib-IIa, fewer than 3 tumors, no major vascular inva‑ sion, and low PDFF derive the greatest benefit, supporting this approach as an effective conversion strategy.

Source: Videosurgery and Other Miniinvasive Techniques

DOI: 10.20452/wiitm.2025.17992

Authors: Yajuan Cao, Liaoliao Sun, Decai Yu

Institutions: Nanjing Drum Tower Hospital, Nanjing University

Language: English

Topic: Hepatocellular Carcinoma Treatment and Prognosis

Subfield: Hepatology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,480