Efficacy and safety of transarterial chemoembolization plus donafenib with or without camrelizumab for unresectable hepatocellular carcinoma: a propensity score matching analysis

Purpose: To compare the efficacy and safety of transarterial chemoembolization plus donafenib (TACE+D) and TACE plus donafenib combined with camrelizumab (TACE+D+C) in unresectable hepatocellular carcinoma (uHCC), using propensity score matching (PSM) to minimize selection bias. Methods: A single-center retrospective study analyzed 278 patients with uHCC who received treatment between 2021 and 2024, and they were divided into TACE+D and TACE+D+C groups. PSM was used to perform 1:1 matching (58 patients per group). Tumor response, progression-free survival (PFS), overall survival (OS), and treatment-related adverse events (TRAEs) were compared; Cox regression was used to identify prognostic factors. Results: < 0.001). Although the TACE+D+C group exhibited immune-related adverse events (irAEs) (e.g., hypothyroidism and reactive cutaneous capillary endothelial proliferation), no significant differences were observed between the two groups in drug-related TRAEs, TRAEs after TACE, or Grade 3 TRAEs. Conclusion: The TACE+D+C group significantly improves ORR, PFS and OS in uHCC patients with a comparable safety profile to the TACE+D group, while the single-center retrospective design limits generalizability, warranting prospective studies.