Impact of TACE combined with targeted and immune therapy on liver function and prognosis in unresectable hepatocellular carcinoma patients: the significance of baseline albumin-bilirubin grade.

BACKGROUND

Transarterial chemoembolization combined with tyrosine kinase inhibitors and immune checkpoint inhibitors (TTI) has emerged as a promising strategy for unresectable hepatocellular carcinoma (uHCC); however, its impact on liver function and the prognostic role of baseline albumin-bilirubin (ALBI) grade remain insufficiently defined.

OBJECTIVES

To compare the effects of combined therapy and transarterial chemoembolization (TACE) alone on liver function in uHCC patients, and to evaluate the prognostic value of baseline ALBI grade.

DESIGN

This retrospective study enrolled uHCC patients treated with TTI or TACE alone between January 2018 and December 2023.

METHODS

The primary outcome was the time to progression of baseline ALBI grade, with secondary outcomes including overall survival (OS) and progression-free survival (PFS) of patients. Survival outcomes were analyzed using the Kaplan-Meier method.

RESULTS

A total of 162 patients (TTI group: 68; TACE alone group: 94) were included. The TTI group showed a significantly longer median time to progression of baseline ALBI grade than the TACE alone group (19.0 months vs 11.6 months, p = 0.004). Subgroup analyses revealed similar benefits of the TTI group (11.3 months vs 5.0 months for baseline ALBI grade 1, p = 0.015; 20.0 months vs 14.7 months for baseline ALBI grade 2, p = 0.025). Patients in the TTI group demonstrated superior median OS (42.2 months vs 22.0 months for baseline ALBI grade 1, p = 0.077; 22.6 months vs 13.5 months for baseline ALBI grade 2, p = 0.001) and longer median PFS (11.7 months vs 6.8 months for baseline ALBI grade 1, p = 0.148; 8.4 months vs 4.9 months for baseline ALBI grade 2, p = 0.022) compared to the TACE alone group.

CONCLUSION

TTI therapy preserved liver function for a longer duration and achieved better survival outcomes than TACE alone in uHCC patients, particularly benefiting those with baseline ALBI grade 2.