Clinical outcomes of hepatitis B virus-related versus non-B non-C hepatocellular carcinoma treated with transarterial chemoembolization, tyrosine kinase inhibitors, and PD-1 inhibitors: a retrospective cohort study
Year: 2026
Type: article
Abstract: Background: As non-B non-C hepatocellular carcinoma (NBNC-HCC) becomes increasingly common in China and transarterial chemoembolization (TACE)-based combination therapy is increasingly used, whether clinical outcomes differ between hepatitis B virus (HBV)-related HCC (HBV-HCC) and NBNC-HCC remains unclear. We compared treatment response and survival outcomes between the two groups. Methods: This single-center retrospective cohort included consecutive patients with Barcelona Clinic Liver Cancer (BCLC) stage B or C HCC treated from January 2020 to December 2024. All patients received conventional TACE plus a tyrosine kinase inhibitor (TKI) and programmed cell death protein 1 (PD-1) inhibitor as initial combination therapy. Hepatitis C virus-related HCC and HBV/HCV coinfection were excluded. Tumor response was assessed according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Progression-free survival (PFS) was defined from the first TACE procedure to radiological progression or death, whichever occurred first, and overall survival (OS) from the first TACE procedure to death. Multivariable logistic and Cox regression analyses were performed. Results: A total of 200 patients were included, comprising 144 with HBV-HCC and 56 with NBNC-HCC. The objective response rate (ORR) was 62.5% in the HBV-HCC group and 48.2% in the NBNC-HCC group. After multivariable adjustment, NBNC-HCC was associated with lower odds of objective response [adjusted odds ratio (OR) =0.436, 95% confidence interval (CI): 0.212-0.877; P=0.02]. Median PFS was 10.0 months in the HBV-HCC group and 5.6 months in the NBNC-HCC group, and NBNC-HCC was independently associated with shorter PFS [adjusted hazard ratio (HR) =1.51, 95% CI: 1.07-2.14; P=0.02]. Median OS was 24.1 and 18.8 months, respectively (log-rank P=0.03); however, after accounting for time-varying covariate effects in the extended Cox model, etiological group was not independently associated with OS (adjusted HR =1.21, 95% CI: 0.79-1.87; P=0.39). No treatment-related deaths were documented. Conclusions: NBNC-HCC was associated with a lower objective response and shorter PFS than HBV-HCC after multivariable adjustment, whereas no independent association between etiological group and OS was observed. Further prospective studies with more detailed etiological and treatment characterization are warranted.
Language: English
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7223380520