Anxiety, depression, and quality of life in hepatocellular carcinoma treated with drug-eluting microspheres plus lenvatinib: A prospective study

doi:10.5498/wjp.v16.i4.116158

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Apr 19, 2026 (publication date) through Mar 30, 2026

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World Journal of Psychiatry

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2220-3206

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Prospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Psychiatry. Apr 19, 2026; 16(4): 116158
Published online Apr 19, 2026. doi: 10.5498/wjp.v16.i4.116158

Anxiety, depression, and quality of life in hepatocellular carcinoma treated with drug-eluting microspheres plus lenvatinib: A prospective study

Jian-Yu Liu, Zhi-Hui Liang, Jing-Lei Liu, Liang Li, Bao Cui, Tie-Gang Li

Jian-Yu Liu, Zhi-Hui Liang, Jing-Lei Liu, Liang Li, Bao Cui, Department of Interventional Treatment, The 980^th (Bethune International Peace) Hospital of the Joint Support Force of the Chinese People’s Liberation Army, Shijiazhuang 050082, Hebei Province, China

Tie-Gang Li, Department of Oncology, The 980^th (Bethune International Peace) Hospital of the Joint Support Force of the Chinese People’s Liberation Army, Shijiazhuang 050082, Hebei Province, China

Author contributions: Liu JY and Liang ZH were the guarantors and designed the study; Liu JY, Liang ZH, and Liu JL participated in the acquisition, analysis, and interpretation of the data and drafted the initial manuscript; Li L, Cui B, and Li TG revised the article critically for important intellectual content; all the authors participated in this study and jointly reviewed and edited the manuscript.

Supported by 2023 Hebei Provincial Medical Scientific Research Project Plan, No. 20231304.

Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the 980^th (Bethune International Peace) Hospital of the Joint Support Force of the Chinese People’s Liberation Army (Approval No. BIPH-2022-KY-011).

Clinical trial registration statement: This study involved no randomization or investigational intervention; therefore, clinical trial registration was not required.

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: The authors declare no conflicts of interest.

CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.

Data sharing statement: There are no additional data available.

Corresponding author: Jian-Yu Liu, MD, Associate Chief Physician, Department of Interventional Treatment, The 980^th (Bethune International Peace) Hospital of the Joint Support Force of the Chinese People’s Liberation Army, No. 398 Zhongshan West Road, Qiaoxi District, Shijiazhuang 050082, Hebei Province, China. ljiany109527@163.com

Received: November 21, 2025
Revised: December 20, 2025
Accepted: January 12, 2026
Published online: April 19, 2026
Processing time: 128 Days and 23 Hours

Abstract

BACKGROUND

Patients with hepatocellular carcinoma (HCC) often experience considerable psychological distress that affects their quality of life (QoL).

AIM

To investigate the effects of drug-eluting microsphere - transcatheter arterial chemoembolization (DEM-TACE) combined with lenvatinib on anxiety, depression, and QoL.

METHODS

This prospective study enrolled 126 patients with primary HCC treated with DEM-TACE combined with lenvatinib from October 2022 to October 2025. Anxiety and depression assessment with the Hospital Anxiety and Depression Scale (HADS) and QoL evaluation with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) and HCC-specific module were conducted at baseline and at 3-, 6-, and 12-month. Clinical outcomes, including overall survival, progression-free survival, and adverse events (AEs), were recorded.

RESULTS

Overall, 58.7% and 61.1% of patients exhibited anxiety and depression at baseline, respectively. After treatment, both psychological status and QoL significantly improved. At 12 months, the prevalence rates of anxiety and depression decreased to 31.0% and 28.6%, respectively (both P < 0.001). The EORTC QLQ-C30 global health status score increased from 52.3 ± 15.7 to 71.2 ± 14.3 (P < 0.001). Physical, role, and emotional functioning scores also significantly improved (all P < 0.001). Treatment-related AEs were generally manageable. Multivariate analysis showed that baseline HADS score, Barcelona Clinic Liver Cancer stage, and tumor response were independent predictors of QoL outcomes (P < 0.05).

CONCLUSION

DEM-TACE combined with lenvatinib shows an acceptable safety profile and favorable efficacy in improving anxiety, depression, and QoL in patients with HCC. Early psychological assessment and intervention may optimize outcomes.

Keywords: Anxiety; Depression; Drug-eluting microspheres; Hepatocellular carcinoma; Lenvatinib; Quality of life

Core Tip: This study investigated the impact of drug-eluting microsphere - transcatheter arterial chemoembolization (DEM-TACE) combined with lenvatinib on anxiety, depression, and quality of life (QoL) in patients with hepatocellular carcinoma (HCC). Among 126 enrolled patients, the prevalence of anxiety and depression significantly decreased over 12 months, accompanied by marked improvements in global health and functional scores on European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 and Quality of Life Questionnaire-Hepatocellular Carcinoma 18. The combination therapy showed favorable tumor response and manageable toxicity. These findings highlight the dual benefits of DEM-TACE plus lenvatinib in improving both psychological well-being and overall QoL in HCC management.