Relationship between transarterial chemoembolization treatment frequency and prognosis in hepatocellular carcinoma patients

Transarterial chemoembolization (TACE) is an important treatment for intermediate-stage hepatocellular carcinoma (HCC) that often needs to be repeated. However, the optimal number of treatments remains unclear, and the relationship between repeated TACE and patient prognosis is complex and needs to be systematically investigated. Evidence shows that the initial efficacy of TACE is significant; however, with an increase in the number of treatments, the objective response rate of the tumor decreases, and TACE-related liver injury accumulates, which becomes a key factor restricting the long-term survival of patients with HCC. In recent years, the new paradigm of TACE combined with targeted therapy plus immunotherapy has shown significant advantages, improving the tumor remission rate, reducing the number of TACE required, and protecting liver function. In terms of prognosis prediction, the model is evolving from a static model based on baseline characteristics to a dynamic model that integrates treatment response. Frontier research has further explored prognostic prediction models based on genomics, radiomics, and machine learning, providing a direction for achieving higher accuracy of individualized prognostic prediction. This narrative review aims to synthesize the current evidence, explore the relationship between the number of TACE treatments and the prognosis of HCC patients, compare TACE alone versus TACE combined with systemic therapy, and review the methodological progress of prognosis-prediction models.