Clinical and radiomic characteristics of transarterial chemoembolization combined with immunotherapy in hepatocellular carcinoma

Abstract

BACKGROUND

Hepatocellular carcinoma (HCC) is associated with a poor prognosis. Intermediate- to advanced-stage HCC patients are commonly administered transarterial chemoembolization (TACE). Recently, TACE combined with immunotherapy has emerged as a promising therapeutic strategy; however, there is substantial interindividual heterogeneity in treatment responses. Therefore, developing efficient predictive biomarkers for therapeutic success is essential for attaining individualized therapy.

AIM

To assess the short-term efficacy of TACE in conjunction with immunotherapy against TACE monotherapy in patients with intermediate-advanced HCC, while also preliminarily investigating the clinical, serological, and radiomic characteristics associated with the efficacy of the combination treatment.

METHODS

This retrospective study analyzed 120 intermediate-advanced HCC patients admitted to our hospital between January 2023 and January 2025. Of these patients, 60 received TACE + immunotherapy (combined group), while 60 received TACE monotherapy (TACE group). The objective response rate, disease control rate at 3 months post-treatment, and changes in serum levels of tumor markers (α-L-fucosidase, alpha-fetoprotein, carbohydrate antigen 19-9), angiogenic factors (hepatocyte growth factor, vascular endothelial growth factor, platelet-derived growth factor, basic fibroblast growth factor), and apoptosis-related molecules (cysteine aspartic protease-3, survivin) before and after treatment were compared between the two groups. Based on the modified response evaluation criteria in solid tumors, the combination cohort was further stratified into responders (complete response/partial response) and non-responders (stable disease/progressive disease). The differences and correlations between baseline clinical characteristics and radiomic features (e.g., entropy, gray-level variance, texture features) were acquired from pre-treatment computed tomography/magnetic resonance imaging scans.

RESULTS

The objective response rate (36.7% vs 23.3%) and disease control rate (76.7% vs 60.0%) in the combination group were substantially higher than those in the TACE group (both P < 0.05). The combination group had superior efficacy in reducing serum tumor marker levels, suppressing angiogenic factors, upregulating cysteine aspartic protease-3 expression, and downregulating survivin expression relative to the TACE group (all P < 0.05). Moreover, the combination group’s radiomic features (including gray-level co-occurrence matrix contrast, arterial-phase entropy, and gray-level variance) were significantly correlated with clinical features, including tumor volume, number, and location (all P < 0.05). However, there were no significant differences in baseline clinical characteristics between responders and non-responders.

CONCLUSION

TACE + immunotherapy indicated improved short-term efficacy and serological molecules modulation compared with TACE monotherapy in intermediate-advanced HCC patients. Radiomic features can quantitatively reflect tumor heterogeneity and correlate with basic tumor characteristics, indicating their potential as non-invasive biomarkers. However, the predictive value of these radiomic characteristics for the effectiveness of combination therapy necessitates more validation in prospective investigations.

Keywords: Hepatocellular carcinoma; Transarterial chemoembolization; Immunotherapy; Therapeutic efficacy; Radiomics; Prediction

Core Tip: Transarterial chemoembolization + immunotherapy co-treatment can significantly improve short-term objective response rate and disease control rate in intermediate-advanced hepatocellular carcinoma patients and more effectively regulate relevant serum biomarkers. Radiomic features extracted from pre-treatment imaging can serve as a potential strategy for constructing personalized efficacy prediction models.