Tumor growth rate for prognostic stratification and treatment optimization in unresectable hepatocellular carcinoma treated with TACE combined with systemic therapy.

[BACKGROUND] Tumor growth rate (TGR) is a dynamic biomarker for evaluating therapeutic response and prognosis in unresectable hepatocellular carcinoma (uHCC) with triple therapy, yet its clinical utility and role in guiding treatment optimization require further validation.

[METHODS] This study included 68 uHCC patients receiving transarterial chemoembolization (TACE) with systemic combination therapy. Propensity score matching (PSM) was applied to balance baseline confounders. Cubic spline models explored nonlinear associations between TGR and survival risk and found the ideal cut-off points. Kaplan-Meier (KM) analysis compared overall survival (OS) and progression-free survival (PFS) between TGR subgroups, Cox multivariate regression evaluated the independent prognostic value of TGR.

[RESULTS] Cox analysis confirmed TGR0 as an independent prognostic factor for OS (hazard ratio (HR) 1.035, 95% confidence interval (CI): 1.013-1.057, p = 0.020) and PFS (HR 1.033, 95%CI: 1.014-1.053, p = 0.001). After stratified for TGR0/TGR1 and matched, the low-TGR0 group showed significantly longer median OS (not reached vs. 13.09 months, p = 0.002) and PFS (12.11 vs. 4.38 months, p = 0.006) than the high-TGR0 group. In the subgroup analysis, after propensity score matching(PSM), the low-TGR1 group demonstrated a more favorable prognosis compared with high-TGR1(mOS: not reached vs. 16.97 months, p = 0.024; mOS1: not reached vs. 11.78 months, p = 0.022).

[CONCLUSIONS] Dynamic TGR monitoring identifies heterogeneous therapeutic responses, guiding timely personalized treatment adjustments and prognostic stratification in uHCC.