Retrospective Study
Copyright ©The Author(s) 2024.
World J Gastrointest Surg. Sep 27, 2024; 16(9): 2829-2841
Published online Sep 27, 2024. doi: 10.4240/wjgs.v16.i9.2829
Table 1 Characteristics of the patients
Characteristics
Values
Age (years), median (P25-P75)53 (47.5-58)
    < 60, n (%)49 (87.50)
    ≥ 60, n (%)7 (12.50)
Sex, n (%)
    Male50 (89.29)
    Female6 (10.71)
Viral infection, n (%)
    Hepatitis B virus42 (75.00)
    Hepatitis C virus3 (5.36)
    Hepatitis B and C viruses11 (19.64)
Prior cancer treatment modalities, n (%)
    Untreated24 (42.86)
    Surgery6 (10.71)
    Ablation therapy3 (5.36)
    TACE23 (41.07)
Line of immunotherapy, n (%)
    First-line49 (87.5.0)
    Second-line5 (8.93)
    Third-line and beyond2 (3.57)
Immunotherapy cycles4 (3-8.5)
    ≤ 4 cycles29 (51.79)
    > 4 cycles27 (48.21)
TACE sessions, median (P25-P75)1 (1-2)
    1 time, n (%)36 (64.29)
    2 times, n (%)13 (23.21)
    3 times or more, n (%)7 (12.50)
Immunotherapy sequence, n (%)
    Before21 (37.50)
    After35 (62.50)
Concomitant targeted/immunotherapy, n (%)
    No5 (8.93)
    Yes51 (91.07)
Targeted/immunotherapy agents, n (%)
    Lenvatinib36 (64.29)
    Apatinib3 (5.36)
    Bevacizumab3 (5.36)
    Regorafenib6 (10.71)
    Sorafenib3 (5.36)
Targeted therapy duration (months), median (P25-P75)5 (3-9)
Tumor maximum diameter (mm), median (P25-P75)65 (39-93.5)
Tumor distribution, n (%)
    Unilateral liver34 (60.71)
    Bilateral liver22 (39.29)
Vascular invasion, n (%)21 (37.50)
Extrahepatic metastasis, n (%)7 (12.50)
BCLC staging, n (%)
    A4 (7.14)
    B16 (28.57)
    C36 (64.29)
Child-Pugh score, n (%)
    A55 (98.21)
    B1 (1.79)
ECOG performance status, n (%)
    054 (96.43)
    12 (3.57)
AFP (ng/mL), median (P25-P75)227.29 (38.7-9484.5)
ALT (IU/L), median (P25-P75)38.9 (26.25-60.7)
AST (IU/L), median (P25-P75)46 (34.25-76.2)
Total bilirubin (µmol/L), median (P25-P75)16.4 (12.65-23.025)
Table 2 Response evaluation

Number of patients
ORR (95%CI)
DCR (95%CI)
Total560.821 (0.717-0.923)0.875 (0.781-0.96)
Age (years)
    < 60490.816 (0.704-0.929)0.878 (0.782-0.973)
    ≥ 6070.857 (0.508-1.207)0.857 (0.508-1.207)
Sex
    Male500.8 (0.685-0.915)0.86 (0.76-0.96)
    Female61 (1-1)1 (1-1)
Viral infection
    Hepatitis B virus420.81 (0.686-0.933)0.833 (0.716-0.951)
    Hepatitis C virus30.667 (-0.768-2.101)1 (1-1)
    Hepatitis B and C viruses110.909 (0.707-1.112)1 (1-1)
Prior cancer treatment modalities
    Untreated240.87 (0.721-1.018)0.913 (0.788-1.038)
    Surgery & Ablation therapy90.7 (0.354-1.046)0.8 (0.498-1.102)
    TACE230.87 (0.721-1.018)0.913 (0.788-1.038)
Line of immunotherapy
    First-line490.857 (0.756-0.959)0.918 (0.839-0.998)
    Second-line and above70.571 (0.077-1.066)0.571 (0.077-1.066)
Immunotherapy cycles
    ≤ 4 cycles290.862 (0.729-0.996)0.897 (0.779-1.014)
    > 4 cycles270.778 (0.61-0.945)0.852 (0.709-0.995)
Transarterial chemoembolization sessions,
    1 time360.889 (0.781-0.997)0.917 (0.822-1.012)
    2 times and above200.7 (0.48-0.92)0.8 (0.608-0.992)
Immunotherapy sequence
    Before210.714 (0.504-0.925)0.762 (0.563-0.961)
    After350.886 (0.775-0.997)0.943 (0.862-1.024)
Concomitant targeted/immunotherapy
    No50.8 (0.245-1.355)0.8 (0.245-1.355)
    Yes510.824 (0.715-0.932)0.882 (0.791-0.974)
Targeted/immunotherapy agents
    Lenvatinib360.889 (0.781-0.997)0.917 (0.822-1.012)
    Apatinib, bevacizumab, regorafenib, or sorafenib150.667 (0.396-0.937)0.8 (0.571-1.029)
Tumor distribution
    Unilateral liver340.941 (0.858-1.025)0.971 (0.911-1.03)
    Bilateral liver220.636 (0.418-0.855)0.727 (0.525-0.929)
Vascular invasion
    Yes210.8 (0.661-0.939)0.857 (0.735-0.979)
    No350.857 (0.694-1.02)0.905 (0.768-1.042)
Extrahepatic metastasis
    Yes70.816 (0.704-0.929)0.878 (0.782-0.973)
    No490.857 (0.508-1.207)0.857 (0.508-1.207)
BCLC staging
    A or B200.9 (0.756-1.044)0.95 (0.845-1.055)
    C360.9 (0.756-1.044)0.95 (0.845-1.055)
Table 3 Adverse events

n (%)
Elevated ALT
    Grade 0-251 (91.07)
    Grade ≥ 3 5 (8.93)
Elevated AST
    Grade 0-250 (89.29)
    Grade ≥ 3 6 (10.71)
Elevated total bilirubin
    Grade 0-254 (96.43)
    Grade ≥ 32 (3.57)
Rash
    Grade 0-254 (96.43)
    Grade ≥ 32 (3.57)
Itching
    Grade 0-256 (100.00)
    Grade ≥ 30
Vomiting
    Grade 0-256 (100.00)
    Grade ≥ 30
Diarrhea
    Grade 0-256 (100.00)
    Grade ≥ 30
Sensory abnormalities
    Grade 0-256 (100.00)
    Grade ≥ 30
Thyroiditis
    Grade 0-256 (100.00)
    Grade ≥ 30
Abdominal pain
    Grade 0-256 (100.00)
    Grade ≥ 30
Gastric ulcer
    Grade 0-256 (100.00)
    Grade ≥ 30
Bone marrow suppression
    Grade 0-256 (100.00)
    Grade ≥ 30