TACE Combined with Targeted Immunotherapy: A Strategy for Liver Transplantation Conversion and Survival Benefits in Patients with BCLC Stage B/C HCC

Background: Patients with BCLC stage B or C hepatocellular carcinoma (HCC) often face long waiting times. The effectiveness of different tumor control strategies remains unclear. This study evaluates preoperative conversion therapies for liver transplantation (LT). Methods: This study retrospectively analyzed 269 patients with HCC at BCLC stage B or C from a single center from January 2015 to August 2024. All these patients underwent liver transplantation. They were divided into three groups by treatment: transcatheter arterial chemoembolization (TACE) (n = 150), TACE + tyrosine kinase inhibitor (TKI) (n = 74), and TACE + TKI+immune checkpoint inhibitors (ICI) (n = 45). Preoperative assessments included blood tests, liver and kidney function, coagulation, tumor markers, and imaging to evaluate tumor response and monitor adverse events. Data collected included baseline characteristics, lab results, surgical details, preoperative treatment response, adverse events, 1-year survival, tumor-free survival, and donor information. Results: = 11.592, 18.111, 17.558). It also had longer RFS versus both control groups (vs. TACE alone: P = 0.008; vs. TACE + TKI: P = 0.040). One-year OS did not differ significantly among groups (P = 0.707). Safety analyses revealed no significant differences in preoperative lab values, adverse event rates, or intraoperative liver transplant parameters (all P > 0.05), confirming prior treatments did not compromise surgical feasibility or safety. Multivariate logistic regression identified treatment regimen as an independent predictor of DCR (P=0.002), ORR (P<0.001), and CRRP (P<0.001). Multivariate Cox regression confirmed it as an independent predictor of RFS (P<0.01). After a 1-month washout, rejection rates did not differ significantly among the three patient groups, and treatment method was not associated with rejection risk (P=0.549). Conclusion: In the conversion therapy of HCC, the combination of TACE + TKI + ICI has demonstrated higher efficacy, longer recurrence-free survival, manageable safety, and does not interfere with subsequent LT.