Clinical efficacy of TACE combined with camrelizumab and apatinib in the treatment of elderly patients with intermediate-advanced hepatocellular carcinoma

Transarterial chemoembolization (TACE) combined with targeted therapy and immunotherapy has emerged as a promising strategy for hepatocellular carcinoma (HCC). However, evidence specific to elderly patients (≥ 60 years) remains limited. This study evaluated the efficacy and safety of TACE combined with camrelizumab and apatinib in elderly patients with intermediate-advanced HCC. A retrospective analysis was conducted on 100 elderly patients with intermediate-advanced HCC treated between June 2021 and June 2024. Patients were divided into an observation group (TACE + camrelizumab + apatinib, n = 50) and a control group (TACE + apatinib, n = 50) using propensity score matching (1:1, caliper 0.02). Objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), immune function markers, tumor markers, and adverse events were compared between groups. The observation group demonstrated significantly higher ORR (56.0% vs. 32.0%, P = 0.016) and DCR (86.0% vs. 68.0%, P = 0.033) compared with the control group. Median PFS (11.5 vs. 5.9 months, P < 0.001) and median OS (15.6 vs. 11.6 months, P < 0.001) were significantly prolonged (log-rank test). The 6- and 12-month PFS and OS rates estimated from the Kaplan–Meier curves were also markedly higher in the observation group (6-month PFS: 89.5% vs. 46.1%; 12-month PFS: 45.9% vs. 15.2%; 12-month OS: 70.6% vs. 44.8%), whereas the 6-month OS rate was comparable between groups (98.0% vs. 94.0%). The observation group also showed greater improvements in CD4 + T cell proportion and CD4+/CD8 + ratio, and more pronounced reductions in serum AFP, HSP90α, and CEA levels. The overall incidence of adverse events was comparable between groups (34.0% vs. 26.0%, P = 0.382). In this retrospective, single-center study, the addition of camrelizumab to TACE plus apatinib was associated with improved treatment response, immune function, and survival outcomes in elderly patients with intermediate-advanced HCC who met the inclusion criteria, with a manageable safety profile. These findings are limited by the retrospective design and modest sample size, and require confirmation in prospective multicenter studies.