Prognostic effect and prognostic factors of TACE for the treatment of unresectable hepatocellular carcinoma: Propensity score matching analysis

Hepatocellular carcinoma (HCC) remains a global challenge due to its high morbidity and mortality as well as its adverse response to treatment. Transcatheter arterial chemoembolization (TACE) is widely used in the treatment of unresectable (u)HCC. However, no consensus has been reached regarding the optimal number of TACE sessions for uHCC. The present study aimed to evaluate the prognostic value of TACE treatment frequency in patients with uHCC and identify factors affecting prognosis. Data were collected from patients with HCC treated with TACE in Hebei General Hospital (Shijiazhuang, China) between January 2017 and December 2023. Patients were divided into three groups based on number of TACE treatments: TACE 1 (one time), 2 (two times) and 3 (≥3 times). The outcomes assessed included objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS) and safety profiles. The propensity score matching was used to decrease the influence of confounding factors on the outcomes. The best ORR in the TACE 1, 2 and 3 groups was 29.6, 77.8 and 44.4%, respectively (P=0.001); the best DCR was 66.7, 88.9 and 96.3% (P=0.016); median PFS was 5, 14 and 22 months (P=0.0034) and median OS was 8, 21 and 26 months (P=0.0028). No significant differences were observed between groups regarding grade 1/2 adverse events. Hypertension, number of TACE sessions, adverse reactions, targeted therapy/immunotherapy and Barcelona Clinic Liver Cancer (BCLC) stage were independent prognostic factors for PFS; similarly, carbohydrate antigen 199 levels, number of TACE sessions, adverse reactions and BCLC stage were independent prognostic factors for OS. Compared with a single TACE session, two or three TACE sessions were associated with significantly prolonged PFS and OS times; however, no further improvement was observed beyond three sessions. Within the range of one to three TACE sessions, an increased number of TACE sessions was associated with prolonged PFS and OS times, improved prognosis and a favorable safety profile.