Efficacy and safety of TACE with or without MWA followed by sequential targeted and immunotherapy in HCC beyond the up-to-7 criteria.

e16288 Background: Although accumulating evidence suggests survival benefits of transarterial chemoembolization (TACE) combined with microwave ablation (MWA) in early-stage hepatocellular carcinoma (HCC), high-quality data are limited in patients with high tumor burden, particularly beyond the UP-to-7 criteria. This study evaluated the efficacy and safety of TACE with or without MWA followed by sequential targeted and immunotherapy in this population. Methods: We retrospectively analyzed patients with radiologically or histologically confirmed HCC beyond the UP-to-7 criteria who received TACE with or without MWA followed by sequential targeted and immunotherapy. Eligible patients had an ECOG performance status of 0–1, Child–Pugh ≤B7, and were suitable for locoregional therapy. Patients with tumor involvement > 70% of the liver, diffuse disease, or prior systemic or locoregional treatments were excluded. The primary endpoint was progression-free survival assessed by mRECIST; overall survival and safety were secondary endpoints. Baseline was defined as the first TACE. Results: Eighty patients treated between October 2018 and December 2023 were included. The median age was 66 years (range, 45–81); 30 and 40 patients had hepatitis B and C, respectively. Patients had BCLC stages A–C, a median tumor diameter of 7.1 cm, and a median follow-up of 68.4 months. Forty-one patients received TACE followed by targeted and immunotherapy (T+T+I), and 39 received TACE plus MWA followed by targeted and immunotherapy (T+M+T+I). Median progression-free survival was 5.7 vs 11.4 months, and median overall survival was 16.5 vs 40.2 months, respectively. Multivariable Cox regression analysis identified treatment modality as an independent predictor of both progression-free survival and overall survival. No increase in treatment-related adverse events was observed. Conclusions: Based on mRECIST, TACE combined with MWA followed by sequential targeted and immunotherapy appears to be an effective and safe treatment option for HCC beyond the UP-to-7 criteria. PFS and OS by group. T+T+I T+M+T+I P value PFS 0.001 Median, months 5.7（3.6-7.7） 11.4（8.7-14.1） 1-year, % 24.4% 46.2% 2-year, % 2.4% 27.3% 3-year, % 14.5% OS ＜0.001 Median, months 16.5（10.9-22.1） 40.2（34.3-46.2） 1-year, % 65.9% 92.3% 3-year, % 19.5% 63.3% 5-year, % 4.9% 30.6%