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. 2025 Jun 4;30(6):oyaf058.
doi: 10.1093/oncolo/oyaf058.

Long-term survival in advanced unresectable HCC treated with transcatheter arterial chemoembolization combined with lenvatinib and PD-1 inhibitors

Zhen-Xin Zeng  1 , Hua-Chun Song  1 , Yi-Nan Li  1 , Jia-Yi Wu  1   2 , Dong Liang  1   2   3 , Shu-Qun Li  4 , Zhi-Bo Zhang  5 , Shao-Wu Zhuang  6 , Bin Li  7 , Jian-Yin Zhou  8 , De-Yi Liu  1 , Han Li  1 , Xiang-Ye Ou  1 , Rong-Jian Pan  1 , Jun-Yi Wu  1   2 , Mao-Lin Yan  1   2
Affiliations

Long-term survival in advanced unresectable HCC treated with transcatheter arterial chemoembolization combined with lenvatinib and PD-1 inhibitors

Zhen-Xin Zeng et al. Oncologist. .

Abstract

Background: Transcatheter arterial chemoembolization combined with lenvatinib and PD-1 inhibitors (triple therapy) is a promising therapy for unresectable hepatocellular carcinoma (uHCC). We aimed to assess the characteristics and identify predictors of long-term survival (LTS) in advanced uHCC treated with triple therapy.

Methods: Retrospectively reviewed patients with uHCC who underwent triple therapy between June 2018 and May 2023 at 8 hospitals in China. LTS was defined as an overall survival (OS) ≥ 24 months. Kaplan-Meier curves were used to estimate survival. Univariate and multivariate logistic regression analyses were performed to identify predictors of LTS.

Results: A total of 110 patients were included in this study. With a median follow-up of 31.3 months, the median OS and progression-free survival for the entire cohort were 17.9 months (95% confidence interval [CI], 13.8-21.2) and 11.8 months (95% CI, 9.9-15.3), respectively. Thirty-nine (35.5%) patients had LTS, with 36- and 48-month OS rates of 95.8% and 82.1%, respectively. In contrast, the median OS for patients with non-LTS was 10.9 months (95% CI, 9.9-13.2). The independent predictors of LTS were the absence of portal vein tumor thrombus (odds ratio [OR], 13.71; 95% CI, 3.19-88.08; p < .001), absence of extrahepatic metastasis (OR, 7.81; 95% CI, 2.76-25.82; p < .001), and platelet-albumin-bilirubin grade 1 (OR, 3.15; 95% CI, 1.17-9.15; p = .023).

Conclusions: The absence of portal vein tumor thrombus, absence of extrahepatic metastasis, and platelet-albumin-bilirubin grade 1 were significantly associated with LTS. These findings help guide treatment decisions in advanced uHCC.

Keywords: combination therapy; hepatocellular carcinoma; long-term survival; overall survival; predictors.

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Conflict of interest statement

The authors declare no potential conflicts of interest.

None declared.

Figures

Figure 1.
Figure 1.
Patient flowchart. Abbreviations: BCLC, Barcelona Clinic for Liver Cancer; ECOG PS, Eastern Cooperative Oncology Group performance status; LTS, long-term survival; uHCC, unresectable hepatocellular carcinoma.
Figure 2.
Figure 2.
Kaplan-Meier curves for all patients. (A) Overall survival. (B) Progression-free survival.
Figure 3.
Figure 3.
Kaplan-Meier curves for overall survival in patients with LTS and non-LTS. LTS, long-term survival.
See this image and copyright information in PMC

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