Icaritin plus TACE improves survival in advanced HCC with macrovascular invasion: a multicenter cohort study

Icaritin, a prenylated flavonoid extracted from Epimedium, induces apoptosis and modulates immunity with proven antitumor activity in hepatocellular carcinoma (HCC). This study aimed to compare survival outcomes of transarterial chemoembolization (TACE) plus Icaritin versus TACE alone in HCC patients with macrovascular invasion (MVI).

This multicenter retrospective cohort study, conducted from October 2022 to June 2025, included 288 patients with HCC and MVI from five tertiary hospitals. Patients were assigned to either the TACE plus Icaritin group (n = 144) or the TACE monotherapy group (n = 144). Tumor response was evaluated by mRECIST on contrast-enhanced CT/MRI. Overall survival and progression-free survival were estimated using Kaplan Meier curves and compared by log-rank test; prognostic factors were identified via Cox regression.

The Icaritin-TACE group showed significantly better outcomes, with longer median OS (16.3 vs. 13.3 months; P = 0.020) and PFS (8.5 vs. 7.6 months; P = 0.006) than the TACE monotherapy group. The disease control rate (DCR) was also higher in the Icaritin-TACE group (84.0% vs. 72.2%; P = 0.015). Multivariate Cox regression analysis identified ECOG performance status, alpha-fetoprotein (AFP) levels, number of lesions, and maximum lesion diameter as independent predictors of OS, while lesion count was independently associated with PFS. The overall incidence of any grade adverse events was similar between groups.

Icaritin combined with TACE improves OS, PFS, and DCR compared to TACE alone in patients with MVI-associated HCC.