ORIGINAL RESEARCH article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
This article is part of the Research TopicIntegrating Molecular Mechanisms, Immunotherapy, and Drug Sensitivity in Cancer Immunology and OncologyView all 37 articles
Preoperative TACE with PD-1 Inhibitors and TKIs in Beyond "Up-to-Seven" Hepatocellular Carcinoma: A Propensity Score Matched Analysis
Provisionally accepted
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Background: HCC patients beyond the "up-to-seven" criteria face a high risk of recurrence, and optimal perioperative strategies warrant further investigation. This study evaluated the efficacy and safety of neoadjuvant TACE combined with PD-1 inhibitors and TKIs in this population. Methods: We retrospectively analyzed 126 HCC patients who underwent curative liver resection between January 2021 and June 2024. Of these, 73 patients received preoperative TACE with PD-1 inhibitors and TKIs (PST group), and 53 underwent direct surgery without preoperative therapy (Surgery group). PSM was applied to control for confounding factors, resulting in 39 matched pairs. The primary endpoints were RFS and OS, with secondary endpoints including intraoperative blood loss, surgical time, and complications. Results: After matching, the PST group demonstrated significantly superior RFS and OS compared to the Surgery group (P < 0.05). The median RFS was 26 months in the PST group versus 13 months in the Surgery group (P = 0.029). There were no significant differences in postoperative complications between the two groups (P = 0.365). The PST group exhibited longer surgical times (P < 0.001) and slightly higher intraoperative blood loss, suggesting increased surgical complexity due to preoperative therapy. Treatment-related adverse events were predominantly grade 1-2, with few grade 3-4 events. Conclusion: Preoperative TACE with PD-1 inhibitors and TKIs was associated with improved survival without increasing severe complications in beyond "up-to-seven" HCC, suggesting a promising perioperative strategy for high-risk patients.
Keywords: Neoadjuvant Therapy, hepatocellular carcinoma (HCC), Up-to-seven, PropensityScore Matching (PSM), Hepatectomy
Received: 01 Jul 2025; Accepted: 13 Nov 2025.
Copyright: © 2025 Zhong, Liang, Chen, Su, Yang, Yan, Huang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Ming Wang, wangming0610@163.com
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