Addition of Intra-Arterial Therapy to Immunotherapy Improves Outcomes in Unresectable Hepatocellular Carcinoma: Taiwan Multicenter Cohort Study.
Journal
Liver cancer
Start Page
CODEN ACYTA
ISSN
2235-1795
Date Issued
2026-05-05
Author(s)
Lee, Teng-Yu
Lee, Pei-Chang
Shen, Ying-Chun
Hsu, Wei-Fan
Lai, Shiue-Wei
Chang, Ching-Wei
Su, Yung-Yeh
Lin, Po-Ting
Su, Tung-Hung
Dai, Chia-Yen
Hsu, Ching-Sheng
Chen, San-Chi
Rau, Kun-Ming
Lee, I-Cheng
Jhan, Song-Ru
Lai, Hsueh-Chou
Wang, Tsang-En
Liang, Po-Cheng
Lin, Shi-Ming
Tseng, Cheng-Hao
Chang, Pi-Yi
Wu, Shu-Cheng
Wang, Hung-Wei
Lee, Shou-Wu
Huang, Yi-Hsiang
Abstract
Evidence supporting the combination of immunotherapy with intra-arterial therapy (IAT) for unresectable hepatocellular carcinoma (HCC) remains limited. This study aimed to evaluate whether the addition of IAT to first-line immunotherapy improves survival outcomes.
Using the Taiwan Liver Cancer Association (TLCA) Research Group database, we identified patients with unresectable HCC who initiated first-line immunotherapy between May 2017 and January 2024. Patients with Barcelona Clinic Liver Cancer (BCLC) stage A or D disease, prior liver transplantation, or follow-up of <6 weeks were excluded. Eligible patients received either IAT (transarterial chemoembolization, radioembolization, or hepatic arterial infusion chemotherapy) at the initiation of immunotherapy or immunotherapy alone. After 1:3 propensity score matching, 90 and 270 patients were included in the IAT and control groups, respectively. Overall survival (OS) was analyzed using adjusted hazard ratios (aHRs) in a time-dependent model.
The IAT group achieved a higher objective response rate (46.7% vs. 26.3%; < 0.001) and a longer duration of response (median 19.0 [IQR: 9.7-36.6] vs. 11.0 [IQR: 8.4-23.1] weeks; = 0.009) than the control group. IAT was independently associated with improved OS (aHR 0.53, 95% CI: 0.37-0.75; < 0.001). Factors associated with worse OS included Child-Turcotte-Pugh class B (aHR 1.41, 95% CI: 1.01-1.97; = 0.042), albumin-bilirubin grade >1 (aHR 1.58, 95% CI: 1.11-2.27; = 0.012), tumor burden beyond the up-to-7 criteria (aHR 1.67, 95% CI: 1.02-2.74; = 0.043), and portal vein invasion (aHR 1.67; 95% CI: 1.19-2.35; = 0.003). Five-year OS was higher in the IAT group than in the control group (28.7% [95% CI: 17.8-46.2] vs. 16.4% [95% CI: 10.7-25.2]; = 0.007). Landmark and subgroup analyses consistently supported the OS benefit of IAT.
In unresectable HCC, the addition of IAT to first-line immunotherapy improves response rates, prolongs the duration of response, and enhances OS.
Subjects
Advanced stage
Immune checkpoint
Liver cancer
Locoregional therapy
Overall survival
Type
journal article