Comparing neoadjuvant targeted therapy plus transarterial chemoembolization versus triple therapy including immunotherapy in hepatocellular carcinoma: a Chinese multicentre study.

BACKGROUND

Neoadjuvant therapy (NAT) is a promising strategy to improve long-term outcomes in hepatocellular carcinoma (HCC), particularly for patients with borderline resectable. Targeted therapy, transarterial chemoembolization (TACE), immunotherapy, and radiotherapy are all effective NAT strategies for HCC; however, the optimal NAT regimen for HCC remains undefined.

METHODS

This multicentre retrospective study included 64 HCC patients who underwent NAT followed by surgical resection between 2020 and 2024 at four tertiary hospitals in China. Based on the treatment regimen, patients were divided into two groups: the dual-therapy group, which received TACE combined with either lenvatinib or bevacizumab, and the triple-therapy group, which additionally received anti-PD-1/PD-L1 immunotherapy. Survival outcomes and prognostic factors were evaluated using the Kaplan-Meier method and Cox proportional hazards models.

RESULTS

The triple-therapy group demonstrated significantly better progression-free survival (PFS) and overall survival (OS) compared to the dual-therapy group (PFS: HR = 0.450, P = 0.048; OS: HR = 0.437, P = 0.039). Multivariate Cox analysis identified triple therapy, lower tumour burden, and higher pathological response as favourable prognostic factors, whereas vascular invasion and elevated alpha-fetoprotein (AFP) levels were linked to poorer outcomes. Additionally, in this Chinese HCC cohort, the China Liver Cancer (CNLC) staging system appeared to provide superior prognostic stratification compared to the Barcelona Clinic Liver Cancer (BCLC) system.

CONCLUSION

In the context of NAT for HCC, triple therapy-combining TACE, targeted agents, and immunotherapy-appears to be a more effective treatment option compared to dual therapy.