Efficacy of Radiation Therapy Plus Targeted Therapy with or without Immunotherapy for Lymph Node Metastases in Hepatocellular Carcinoma

Background and aims: This study aimed to investigate t he efficacy of radiation therapy and targeted therapy combined with or without immunotherapy for hepatocellular carcinoma (HCC) patients with lymph node metastases (LNM). Methods A total of 132 HCC patients with LNM were enrolled in this study. Propensity score matching (PSM) and stabilized inverse probability of treatment weighting (sIPTW) were used to balance baseline variables between groups. Overall survival (OS), progression-free survival (PFS), objective response rate (ORR), disease control rate (DCR), and clinical safety were compared between the two treatment arms. Results There were 61 patients in radiotherapy plus targeted therapy (RT) group, and 71 patients in radiation therapy, targeted therapy combined with immunotherapy (RTI) group. In the overall cohort, the median OS was 12.8 months in the RT group and 18.8 months in the RTI group ( P  = 0.003). Multivariate analysis identified that tumor thrombus status, distant metastasis, lymph node (LN) number, LN size and immunotherapy were independent prognostic factors for survival. Median PFS was 7.0 months in the RT group and 11.9 months in the RTI groups ( P  = 0.001). The ORRs were 70.5% for the RT group and 85.9% for the RTI group in the total cohort ( P  = 0.031). After PSM and IPTW adjustment, ORR remained significantly higher in the RTI group (PSM: 88.9% vs. 68.9%, P  = 0.020; IPTW: 86.8% vs. 71.5%, P  = 0.033). The incidence of treatment-related adverse events was similar in both groups. Conclusions The findings of this study suggest that RTI provides superior treatment responses and survival outcomes compared to RT in HCC patients with LNM, while maintaining a comparable safety profile.