{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:13:15Z","timestamp":1791825195886,"version":"4.3.4"},"reference-count":32,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver Cancer"],"abstract":"<jats:p>Introduction: Evidence supporting the combination of immunotherapy with intra-arterial therapy (IAT) for unresectable hepatocellular carcinoma (HCC) remains limited. This study aimed to evaluate whether the addition of IAT to first-line immunotherapy improves survival outcomes. Methods: Using the Taiwan Liver Cancer Association (TLCA) Research Group database, we identified patients with unresectable HCC who initiated first-line immunotherapy between May 2017 and January 2024. Patients with Barcelona Clinic Liver Cancer (BCLC) stage A or D disease, prior liver transplantation, or follow-up of &lt;6 weeks were excluded. Eligible patients received either IAT (transarterial chemoembolization, radioembolization, or hepatic arterial infusion chemotherapy) at the initiation of immunotherapy or immunotherapy alone. After 1:3 propensity score matching, 90 and 270 patients were included in the IAT and control groups, respectively. Overall survival (OS) was analyzed using adjusted hazard ratios (aHRs) in a time-dependent model. Results: The IAT group achieved a higher objective response rate (46.7% vs. 26.3%; p &lt; 0.001) and a longer duration of response (median 19.0 [IQR: 9.7\u201336.6] vs. 11.0 [IQR: 8.4\u201323.1] weeks; p = 0.009) than the control group. IAT was independently associated with improved OS (aHR 0.53, 95% CI: 0.37\u20130.75; p &lt; 0.001). Factors associated with worse OS included Child-Turcotte-Pugh class B (aHR 1.41, 95% CI: 1.01\u20131.97; p = 0.042), albumin-bilirubin grade &gt;1 (aHR 1.58, 95% CI: 1.11\u20132.27; p = 0.012), tumor burden beyond the up-to-7 criteria (aHR 1.67, 95% CI: 1.02\u20132.74; p = 0.043), and portal vein invasion (aHR 1.67; 95% CI: 1.19\u20132.35; p = 0.003). Five-year OS was higher in the IAT group than in the control group (28.7% [95% CI: 17.8\u201346.2] vs. 16.4% [95% CI: 10.7\u201325.2]; p = 0.007). Landmark and subgroup analyses consistently supported the OS benefit of IAT. Conclusion: In unresectable HCC, the addition of IAT to first-line immunotherapy improves response rates, prolongs the duration of response, and enhances OS.<\/jats:p>","DOI":"10.1159\/000552375","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T16:00:58Z","timestamp":1777996858000},"page":"1-13","source":"Crossref","is-referenced-by-count":1,"title":["Addition of Intra-Arterial Therapy to Immunotherapy Improves Outcomes in Unresectable Hepatocellular Carcinoma: Taiwan Multicenter Cohort 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