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Updated: Jul 7, 2026
Generation and Single-Cell Transcriptomic Analysis of Hepatocellular Carcinoma Organoids following Drug Treatment
Published on: May 26, 2026
Baseline Sleep Quality and Objective Response in HCC Patients Treated with TACE Combined with Lenvatinib and PD-1
Pengfei Tian1, He Zhao1, Wei Sun1
1Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Background:
Sleep disturbance is common in patients with cancer and may reflect host immune, inflammatory, and symptom states relevant to treatment response. In hepatocellular carcinoma (HCC), whether baseline sleep quality is associated with objective response among patients receiving transarterial chemoembolization (TACE) combined with lenvatinib and PD-1 inhibitors remains uncertain.
Methods:
We conducted a secondary analysis of a prospectively registered observational HCC cohort in the Chinese Clinical Trial Registry. Consecutive patients in the cohort who were treated with TACE plus lenvatinib and PD-1 inhibitors were screened; 129 patients with available baseline Pittsburgh Sleep Quality Index (PSQI), Hospital Anxiety and Depression Scale (HADS), and response data were included. Objective response rate (ORR) was assessed using modified Response Evaluation Criteria in Solid Tumors (mRECIST). Multivariable logistic regression adjusted for age, sex, ECOG performance status, ALBI grade, maximum tumor diameter, tumor number, and portal vein tumor thrombosis. Unstabilized inverse-probability complete-case weighting and multiple imputation were used as sensitivity analyses.
Results:
The mean age was 60.9 years, 94 patients (72.9%) were male, and 64 of 129 patients (49.6%) achieved ORR. Responders had better baseline sleep quality than non-responders (mean PSQI 4.14 vs 7.94; p<0.001). After adjustment, each 1-point increase in PSQI was associated with lower odds of ORR (OR 0.62, 95% CI 0.48-0.75; p<0.001). The association was similar after inverse-probability weighting (OR 0.63, 95% CI 0.52-0.75; p<0.001) and multiple imputation (OR 0.66, 95% CI 0.55-0.79; p<0.001). Baseline HADS-Anxiety and HADS-Depression scores were not independently associated with ORR.
Conclusion:
Poorer baseline sleep quality was independently associated with a lower probability of objective response in HCC patients treated with TACE plus lenvatinib and PD-1 inhibitors. PSQI may be a feasible baseline risk-stratification tool in this setting, but causal inference is limited and prospective validation is required before sleep-directed interventions can be expected to improve tumor response.
