MV-833

The efficacy and safety of transarterial chemoembolization (TACE) combined with immune checkpoint inhibitors (ICIs) and anti-vascular endothelial growth factor (anti-VEGF) antibody/tyrosine kinase inhibitors (TKIs) have been established. However, it remains unclear whether the addition of TACE to systemic therapies exacerbates liver function deterioration and increases mortality risk.

To assess liver function changes and their impact on prognosis in patients with advanced hepatocellular carcinoma (HCC) treated with ICIs and anti-VEGF antibody/TKIs with or without TACE as first-line therapy.

This is a real-world retrospective cohort study.

Patients with advanced HCC treated with TACE combined with ICIs and anti-VEGF antibody/TKIs (TACE-ICI-VEGF) or ICIs and anti-VEGF antibody/TKIs alone (ICI-VEGF) from January 2018 to June 2024 were retrospectively included. The primary outcomes were changes in albumin-bilirubin (ALBI) score and time to deterioration (TTD) of liver function. The secondary outcomes included overall survival (OS), progression-free survival (PFS), and the relationship between TTD and prognosis.

A total of 111 patients were included, with 54 and 57 patients receiving TACE-ICI-VEGF and ICI-VEGF, respectively. Changes in ALBI score were similar between groups (difference in least squares mean, −0.075; 95% confidence interval (CI): −0.298 to 0.148). TTD was also comparable (median for TACE-ICI-VEGF 9.7 months vs. ICI-VEGF 8.5 months; hazard ratio (HR) = 1.19 (95% CI: 0.71–2.01); p  = 0.512). TACE-ICI-VEGF group demonstrated a significantly improved median OS (18.3 vs. 11.8 months; HR = 0.60 (95% CI: 0.37–0.98); p  = 0.041) and a trend toward prolonged median PFS (14.7 vs. 11.2 months; HR = 0.76 (95% CI: 0.47–1.25); p  = 0.278). Patients with liver function deterioration had an increased risk of mortality (median OS: 13.2 vs. 17.0 months; HR = 1.44 (95% CI: 0.88–2.35); p  = 0.139).

TACE combined with ICIs plus anti-VEGF antibodies/TKIs as first-line treatment generally did not adversely affect liver function. Liver function deterioration was associated with an increased risk of mortality.

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