Perioperative Targeted Immunotherapy Combined With Transarterial Chemoembolization Improves Survival in Borderline Resectable Hepatocellular Carcinoma

To compare targeted immunotherapy plus adjuvant transarterial chemoembolization (TACE) versus TACE alone in patients with borderline resectable hepatocellular carcinoma (BR-HCC). 297 BR-HCC patients who underwent liver resection were included. Among them, 86 patients received perioperative targeted immunotherapy combined with adjuvant TACE (combination therapy group, which included neoadjuvant therapy and adjuvant therapy), while 211 received adjuvant TACE alone (TACE-only group). After propensity score matching (PSM), the combination therapy group demonstrated significantly improved 1-, 3-, and 5-year OS rates (90.7%, 66.0%, and 58.1%, respectively) compared to the TACE-only group (86.0%, 55.2%, and 35.1%; p = 0.013). Similarly, 1-, 3-, and 5-year RFS rates were higher in the combination therapy group (66.3%, 36.9%, and 31.0%) than in the TACE-only group (55.8%, 23.1%, and 13.8%; p = 0.007). Multivariable analysis confirmed that combination therapy was an independent protective factor for both OS (HR: 0.619, 95% CI: 0.389-0.983) and RFS (0.665, 0.469-0.944). Subgroup analysis showed that in adjuvant therapy and TACE-only, TACE-only was an independent risk factor for OS (1.986, 1.105-3.566) and RFS (1.831, 1.132-2.962) compared with adjuvant therapy (receiving postoperative adjuvant targeted immunotherapy and TACE). Further analysis showed that in the combination therapy subgroup, adjuvant therapy was an independent risk factor for OS (2.701, 1.171-6.230) and RFS (2.051, 1.125-3.739) compared to neoadjuvant therapy (receiving both preoperative neoadjuvant and postoperative adjuvant targeted immunotherapy and TACE). No significant difference in complications/AEs following surgery/TACE was observed between the two groups. Perioperative targeted immunotherapy combined with adjuvant TACE significantly improves OS and RFS in BR-HCC patients without increasing the incidence of complications/AEs following surgery/TACE.