Hepatitis B virus infection and outcomes of TACE plus lenvatinib and PD-1 inhibitor therapy in unresectable hepatocellular carcinoma: a real-world propensity score-matched study

BackgroundThe combination of transarterial chemoembolization (TACE), lenvatinib, and PD-1 inhibitors has shown promising efficacy in treating advanced hepatocellular carcinoma (HCC). However, the impact of hepatitis B virus (HBV) infection on the outcomes of this therapy remains unclear.

This study aims to assess the association between HBV infection status and clinical outcomes in patients with initially unresectable HCC undergoing triple therapy.MethodsThis retrospective single-center cohort study included 190 consecutive uHCC patients treated with triple therapy between February 2022 and February 2025. Patients were stratified into HBV-positive (n = 133) and HBV-negative (n = 57) groups based on HBsAg status.

Propensity score matching (PSM, 1:1, caliper 0.02) was performed to balance baseline characteristics. The primary endpoint was surgical conversion.

Secondary endpoints included tumor response (mRECIST), overall survival (OS), progression-free survival (PFS), and treatment-related adverse events (AEs). Landmark analyses, subgroup analyses and multivariate Cox regression were used to evaluate clinical outcomes and independent prognostic factors.ResultsCompared to HBV-negative patients, HBV-positive patients achieved significantly higher surgical conversion rates both before PSM (25.6% vs.

12.3%, P = 0.041) and after PSM (20% vs. 10%, P = 0.021).