Comparison of the efficacy of transarterial chemoembolization combined with radiofrequency ablation or sintilimab and bevacizumab for unresectable hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is a leading cause of cancer mortality. For patients with unresectable HCC, transarterial chemoembolization (TACE) combined with either radiofrequency ablation (RFA) or systemic therapy (e.g., sintilimab and bevacizumab) are emerging strategies. This study aims to compare the efficacy and safety of TACE-RFA versus TACE combined with sintilimab and bevacizumab in unresectable HCC. This retrospective cohort study included 207 patients with unresectable HCC treated from January 2021 to June 2022: 93 received TACE combined RFA and 114 received TACE combined sintilimab and bevacizumab. Baseline characteristics, laboratory parameters, tumor response, adverse events, and survival outcomes (overall survival [OS] and progression-free survival [PFS]) were analyzed. Statistical analyses employed t-tests, χ² tests, Kaplan-Meier/log-rank tests, and multivariable Cox regression to identify independent prognostic factors. Baseline characteristics were comparable. The TACE+dual-drug group achieved a higher objective response rate (ORR: 38.60% vs. 24.73%, P = 0.034) and superior survival outcomes, with longer median OS (27.24 vs. 24.17 months, P < 0.001) and PFS (10.42 vs. 8.13 months, P < 0.001). Multivariable Cox regression identified treatment group and BCLC stage as independent predictors of OS. Compared to TACE + RFA, TACE+dual-drug therapy was associated with a significantly lower risk of death (HR = 0.520, 95% CI: 0.370–0.731, P < 0.001), while BCLC stage C increased the risk of death (HR = 2.106, 95% CI: 1.412–3.146, P < 0.001). Regarding safety, the dual-drug group exhibited more pronounced hematological suppression, coagulopathy, and hepatic dysfunction (P < 0.05). Adverse events (hypertension, hand-foot syndrome, rash) were significantly more common in the TACE+dual-drug group (P < 0.01). TACE combined with sintilimab and bevacizumab improves survival and tumor response over TACE-RFA but with increased systemic toxicity. Patient selection should balance efficacy and tolerability.