[TACE-HAIC versus HAIC combined with targeted immunotherapy for unresectable hepatocellular carcinoma: a propensity...

Objective: To investigate the safety profile and efficacy of transarterial chemoembolization (TACE)-hepatic arterial infusion chemotherapy (HAIC) and HAIC combined with targeted immunotherapy in patients with unresectable hepatocellular carcinoma (uHCC). Methods: Clinical data of patients with uHCC who received TACE-HAIC or HAIC as the initial local therapy from January 2020 to December 2023 were retrospectively analyzed. Propensity score matching (PSM) was used to compare tumor response, progression-free survival (PFS), overall survival (OS), and adverse events between the two groups. Univariate and multivariate analyses of survival were performed using t-tests, χ² tests, Kaplan-Meier curves, or Cox proportional hazards models, according to the varied data. Results: A total of 258 cases were included, with 41 in the HAIC group and 217 in the TACE-HAIC group. Forty-one matched pairs of patients after PSM (n=41 in the HAIC group and n=82 in the TACE-HAIC group) were obtained. The results showed that the objective response rate (ORR) (70.7% vs. 51.2%, P=0.033) and the disease control rate (90.2% vs. 75.6%, P=0.030) were significantly superior in the TACE-HAIC group than in the HAIC group. The PFS (median 12.7 months vs. 7.9 months, P=0.006) and OS (median 24.4 months vs. 18.9 months, P=0.039) were also significantly prolonged in the TACE-HAIC group. There was no statistically significant difference in the incidence of grade 3/4 adverse events between the two groups. Conclusion: Compared with HAIC combined with targeted immunotherapy, TACE-HAIC combined with targeted immunotherapy shows superior tumor control and survival benefits in uHCC, with a favorable safety profile.