Efficacy analysis of icaritin combined with transarterial chemoembolization in hepatocellular carcinoma stratified by different child-pugh classes.

OBJECTIVE: To evaluate if transarterial chemoembolization (TACE) combined with Icaritin provides additional survival benefits compared to TACE alone in intermediate-to-advanced hepatocellular carcinoma (HCC) across different Child-Pugh classes. BACKGROUND: TACE is a standard locoregional therapy for intermediate-to-advanced HCC, yet monotherapy yields limited long-term survival. Icaritin, an immunomodulator, demonstrates survival benefits in advanced HCC with a favorable safety profile lacking severe hepatotoxicity or bone marrow suppression. METHODS: This multicenter retrospective cohort study included patients with Barcelona Clinic Liver Cancer (BCLC) stage B and C HCC. Propensity score matching (PSM) was utilized to balance baseline covariates between the TACE with Icaritin and TACE alone groups. The primary endpoint was overall survival (OS). RESULTS: Following PSM, 250 patients were evaluated. In the Child-Pugh grade A group, TACE combined with Icaritin was associated with longer median OS than TACE alone (28.8 vs. 15.7 months; HR, 0.42; 95% CI, 0.29-0.62; P<0.001). Median PFS was also longer in the combination group (9.7 vs. 8.1 months; HR, 0.66; 95% CI, 0.49-0.90; P = 0.007). In Child-Pugh subgroup analyses, the treatment effect was most consistent in patients with Child-Pugh grade A liver function. In Child-Pugh grade B patients, OS favored the combination therapy, whereas the PFS result was not statistically definitive. ORR (49.6% vs. 47.2%) and DCR (83.2% vs. 74.4%) were comparable. The combination regimen did not significantly increase grade 3-4 liver function-related adverse events. CONCLUSIONS: TACE combined with Icaritin was associated with improved survival outcomes, with the most consistent benefit observed in patients with Child-Pugh grade A liver function. In Child-Pugh grade B patients, the findings should be interpreted cautiously because of the limited subgroup size and insufficient statistical power.