Objective:

To investigate whether synchronized systemic therapy enhances the therapeutic efficacy of TACE in intermediate and advanced-stage HCC, particularly in terms of overall survival.

Key Findings:

• No significant differences in baseline characteristics except for a higher proportion of Child-Pugh A patients in the combination group (90.2% vs. 67.3%, P=0.005).
• Median PFS was similar between groups (5.5 vs. 6.0 months, P=0.832), with no significant differences in BCLC-B (18.3 vs. 17.4 months, P=0.516) or BCLC-C (4.1 vs. 3.7 months, P=0.255) subgroups.
• Combination therapy showed a trend toward improved OS (24.8 vs. 16.7 months, P=0.282), significant in BCLC-C patients (17.9 vs. 11.0 months, P=0.048).
• Grade 3 or 4 adverse events were comparable between groups (7.2% vs. 14.9%, P=0.187).

Interpretation:

Combining systemic therapy with TACE does not improve PFS but may enhance OS in BCLC-C patients, while maintaining a comparable safety profile.

Limitations:

• Retrospective design may introduce bias and confounding factors.
• Single-center study limits generalizability.
• Small sample size in combination group may affect statistical power.

Conclusion:

Further prospective studies are warranted to optimize treatment strategies for HCC, particularly focusing on patient selection and the specific systemic therapies used.