Efficacy of TACE combined with targeted immunotherapy in the treatment of advanced liver cancer.

objectiveTo investigate the efficacy of transcatheter arterial chemoembolization (TACE) combined with targeted immunotherapy in the treatment of advanced liver cancer.

methodA total of 115 patients with intermediate-advanced liver cancer treated in our hospital from June 2021 to June 2024 were retrospectively selected and divided into two groups according to the actual treatment regimen received. The grouping was a non-randomized retrospective design. The conventional group (n = 57) received TACE alone, while the combination group (n = 58) received TACE combined with targeted immunotherapy. Clinical efficacy, tumor markers [alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), carbohydrate antigen 199 (CA199), protein induced by vitamin K absence-II (PIVKA-II)], immune function [immunoglobulin A (IgA), immunoglobulin G (IgG), immunoglobulin M (IgM)], and liver function indicators [serum albumin (ALB), glutamic-pyruvic transaminase (GPT), total bilirubin (TBIL)] were compared between the two groups. Kaplan-Meier survival analysis and the Cox proportional hazards regression model were used to evaluate survival rate, the incidence of adverse events was also compared. To control for potential confounding factors, 1:1 propensity score matching (PSM) was performed as a sensitivity analysis, subgroup analyses of efficacy and safety for different targeted drugs within the combination group were also carried out. Immunohistochemistry was used to detect the expression of Ki-67, CD8 ⁺ T, and PD-L1 in two groups before treatment.

resultCompared with the conventional group, the proportion of objective response rate (ORR), disease control rate (DCR) patients in the combined group was significantly higher (P < 0.05). After treatment, the levels of tumor markers in both groups were significantly reduced, which were lower in the combined group than the conventional group (P < 0.001). After treatment, the immune function in both groups were improved, with the combined group showing superior efficacy compared to the conventional group (P < 0.001). After treatment, the liver function in both groups were improved. The ALB level in the combined group was significantly higher than that in the conventional group, while the GPT and TBIL levels were significantly lower than those in the conventional group (P < 0.001). The one-year cumulative survival rate of patients in the combined group was higher than that of the conventional group (P < 0.05). The overall incidence of grade ≥ 3 adverse events did not differ significantly between the two groups (P > 0.05). After PSM, the DCR and 1-year cumulative survival rate in the combination group remained significantly superior to those in the conventional group (both P < 0.05). Combination therapy was an independent protective factor for survival (HR = 0.520, 95% CI 0.310-0.874, P = 0.012), while CNLC stage IIIa was an independent risk factor (HR = 2.062, 95% CI 1.210-3.514, P = 0.008). The Ki-67 positivity rate and PD-L1 expression were decreased, CD8⁺ T cell infiltration was increased in the combination group after treatment, while the above indicators did not show significant changes in the conventional group.

conclusionIn this retrospective study, compared with TACE alone, TACE combined with targeted immunotherapy significantly reduced tumor marker levels, enhanced immune function, improved liver function, and prolonged survival time in patients with intermediate-advanced liver cancer, demonstrating better clinical efficacy. However, given the heterogeneity of the targeted drug regimens in the combination group, the generalizability of this conclusion requires further validation through prospective randomized controlled studies with standardized protocols.