Survival benefits of complete ablation in patients with BCLC stage B hepatocellular carcinoma receiving transarterial chemoembolization and systemic therapy

Background The role of ablation in BCLC stage B hepatocellular carcinoma (HCC) remains unclear, particularly in the setting of transarterial chemoembolization (TACE) combination with systemic therapy. Our study assessed the impact of ablation on survival and developed a model to identify patients most likely to benefit from the treatment. Methods This retrospective single-center cohort study included 230 patients with BCLC stage B HCC. Patients were classified into TACE plus systemic therapy (TACE + ST, n = 103), TACE plus incomplete ablation with systemic therapy (TACE-IA + ST, n = 42), and TACE plus complete ablation with systemic therapy (TACE-CA + ST, n = 85) groups. The primary endpoint was overall survival (OS), and the secondary endpoint was progression-free survival (PFS). In the ablation cohort, a prognostic scoring was established from independent related factors for OS and internally validated using bootstrap resampling. Result Median PFS was 7.8, 9.9, and 12.3 months in the TACE, TACE-IA, and TACE-CA groups. Median OS was 45.0 months in the TACE group and 36.0 months in the TACE-IA group, whereas median OS was not reached in the TACE-CA group. Significant differences were observed among the three groups for both PFS ( P = 0.0038) and OS ( P < 0.001). In multivariable analysis, compared with TACE alone, TACE-CA was independently associated with improved PFS ( P = 0.007) and OS ( P = 0.002), whereas TACE-IA was not. After IPTW, TACE-CA remained associated with better survival. In the ablation cohort, a score based on tumor size, AFP, and treatment status showed good discrimination. Conclusion In patients with BCLC stage B HCC receiving TACE combined with systemic therapy, complete ablation was associated with improved survival.