ORIGINAL RESEARCH article
Front. Immunol.
Sec. Cancer Immunity and Immunotherapy
Volume 16 - 2025 | doi: 10.3389/fimmu.2025.1664519
Tislelizumab Plus Tyrosine Kinase Inhibitors with TACE Improves Survival in Unresectable Hepatocellular Carcinoma with Clinical Predictors and Manageable Safety
Provisionally accepted
- 1Interventional Medical Center, The Affiliated Hospital of Qingdao University, Qingdao, China
- 2Department of Internal Medicine, Qingdao Cardiovascular Hospital, Qingdao Fuwai Cardiovascular Disease Hospital, Qingdao, China
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Background & Aims: The survival benefit of adding transarterial chemoembolization (TACE) to systemic therapy (tislelizumab plus tyrosine kinase inhibitors [TKIs]) for unresectable hepatocellular carcinoma (HCC) requires validation. This retrospective study compared the efficacy and safety of tislelizumab-TKIs with or without TACE and identified clinical predictors of benefit. Methods: This retrospective analysis included 283 unresectable HCC patients: systemic therapy alone (STG, n=98; tislelizumab plus TKIs) versus combination therapy (CTG, n=185; tislelizumab plus TKIs and TACE). Primary endpoints were overall survival (OS) and progression-free survival (PFS), analyzed by Cox regression. Propensity score matching (PSM) was used to reduce baseline differences between the two groups. Results: After PSM, CTG significantly improved median OS (22.5 [95% confidence interval (CI): 19.0–34.4] vs. 14.0 [12.1–18.6] months; hazard ratio (HR) 0.53, p<0.001) and PFS (14.6 [12.1–19.1] vs. 9.5 [7.8–12.5] months; HR 0.59, p<0.001) versus STG. Multivariate analysis identified independent predictors of poor OS: age <60 years, extrahepatic spread, portal vein thrombus, alpha-fetoprotein (AFP) ≥400 ng/mL, and elevated gamma-glutamyl transferase (GGT). Subgroups with maximal CTG benefit included patients aged ≥60 years, no extrahepatic spread, AFP <400 ng/mL, and normal GGT. CTG had higher all-grade adverse events (79.6% vs. 67.0%, p=0.021) and grade ≥3 events (23.5% vs. 14.1%, p=0.038), primarily manageable liver toxicity and hematological abnormalities. Conclusion: Combining TACE with tislelizumab-TKIs significantly improves survival over systemic therapy alone in unresectable HCC, with maximal benefit observed in patients aged ≥60 years, without extrahepatic spread, with AFP <400 ng/mL, or normal GGT, despite increased manageable toxicity.
Keywords: Hepatocellular Carcinoma, tislelizumab, Tyrosine kinase inhibitors (TKIs), transarterial chemoembolization (TACE), survival analysis
Received: 12 Jul 2025; Accepted: 08 Sep 2025.
Copyright: © 2025 Wang, Cao, Yu, Li, Li, Chang, Zhang 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: Song Wang, Interventional Medical Center, The Affiliated Hospital of Qingdao University, Qingdao, China
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