Survival Analysis of TACE Monotherapy vs. Combination Therapy in BCLC B and C Stage Hepatocellular Carcinoma: A Retrospective Cohort Study

Introduction Standard treatments provide limited benefits for patients with intermediate or advanced hepatocellular carcinoma (HCC). This retrospective observational study aimed to assess potential improvements associated with systemic therapies in patients receiving transarterial chemoembolization (TACE) for initially unresectable HCC. Methods Between February 2019 to March 2023, we reviewed patients diagnosed with intermediate- to-advanced HCC, treated with either TACE or TACE combined with antiangiogenic and immunotherapy (combination group) as their initial treatment. To balance the impact of confounding biases, we further divided the entire study population into surgical and non-surgical cohorts and conducted separate assessments. The analysis focused on comparing the progression-free survival (PFS), overall survival (OS) and safety profile of the combination group with those of TACE monotherapy. Results Out of 279 patients with initially unresectable intermediate or advanced HCC, 156 successfully underwent subsequent curative intent liver resection after preoperative treatments (TACE group, n = 69, combination group, n = 87), while 123 patients continued non-surgical treatments (TACE group, n = 31, combination group, n = 92). After PSM, 26 matched patient pairs were generated in non-surgical cohort. The combination group exhibited a significantly extended PFS for non-surgical patients (9.4 vs. 7.2 months, p  = 0.043). Cox analysis also suggested that this combination therapy regimen was associated with improved PFS in non-surgical cohort (HR = 0.476, 95% CI: 0.257–0.883, p  = 0.019). In surgical patients exceeding up-to-seven criteria, the combination group demonstrated superior median PFS (18.0 vs. 14.6 months, p  = 0.03) and OS (Not reached vs. 50.1 months, p  = 0.049) compared to the TACE group. Adverse events were manageable and did not result in any treatment-related fatalities. Conclusion TACE in combination with systemic antitumor therapy demonstrated improved survival benefits in patients with intermediate to advanced HCC, particularly among surgical patients with higher tumor burden.