Sarcopenia modifies the survival benefit of triple therapy versus TACE alone in elderly patients with unresectable hepatocellular carcinoma: A multicenter retrospective cohort study

). Inverse probability of treatment weighting (IPTW) adjusted for confounding, and treatment-sarcopenia interaction was assessed via weighted Cox regression. After IPTW adjustment, triple therapy significantly improved overall survival (OS; median 12.6 vs 9.3 months; hazard ratio [HR] 1.67, 95% confidence interval [CI] 1.26-2.20; p < 0.001) and progression-free survival (median 6.2 vs 4.2 months; HR 1.86, 95% CI 1.40-2.47; p < 0.001). Sarcopenia was present in 100 patients (43.3%) and significantly modified the treatment effect (p for interaction = 0.049). Among non-sarcopenic patients (n = 131), triple therapy conferred a substantial survival benefit (median OS 19.3 vs 10.6 months; HR 1.97; p < 0.001), whereas no significant benefit was observed in sarcopenic patients (n = 100; median OS 10.4 vs 8.7 months; HR 1.20; p = 0.460). Grade ≥ 3 adverse events were comparable between groups (26.2% vs 16.6%; p = 0.086). These findings support routine sarcopenia assessment to guide treatment selection in elderly patients with unresectable HCC.