TACE-HAIC versus TACE as Initial Regional Therapy for Unresectable Huge Hepatocellular Carcinoma (>10 cm): A Propensity Score-Matched Study.

Purpose: Hepatocellular carcinoma (HCC) remains challenges in treatment, particularly when tumors are unresectable and huge. This study aimed to assess the safety and efficacy of combining transarterial chemoembolization (TACE) with hepatic arterial infusion chemotherapy (HAIC) for this patient population.

Patients and methods: A retrospective review was conducted on patients with unresectable huge HCC (>10 cm) who received either TACE-HAIC or TACE as initial regional treatment from January 2020 to December 2023. Tumor response, progression-free survival (PFS), overall survival (OS), and adverse events were evaluated by propensity score matching (PSM).

Results: Among the 242 patients included, 132 received TACE-HAIC and 110 received TACE. After PSM, 77 matched pairs were analyzed. The TACE-HAIC group had significantly higher objective response (74.0% vs 58.4%, P = 0.040) and disease control rates (93.5% vs 72.7%, P = 0.001) than the TACE group. TACE-HAIC therapy also led to longer PFS (median: 12.3 vs 7.4 months, P < 0.001) and prolonged OS (median: 26.8 vs 20.4 months, P = 0.006). Stratified analysis showed that patients in Barcelona Clinical Liver Cancer stage C had longer survival benefits in the TACE-HAIC group (median PFS: 10.5 vs 5.6 months, P < 0.001; median OS: 24.5 vs 19.8 months, P = 0.013). Among grade 3/4 adverse events, liver abscesses (P = 0.018) were more common in the TACE group.

Conclusion: Compared to TACE alone, TACE-HAIC therapy presented an acceptable safety profile, and offered improved local efficacy and prolonged survival benefits in patients with unresectable huge HCC (> 10 cm).