{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T16:22:38Z","timestamp":1789402958670,"version":"build-2803163510"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To compare the efficacy and safety of transarterial chemoembolization plus donafenib (TACE+D) and TACE plus donafenib combined with camrelizumab (TACE+D+C) in unresectable hepatocellular carcinoma (uHCC), using propensity score matching (PSM) to minimize selection bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A single-center retrospective study analyzed 278 patients with uHCC who received treatment between 2021 and 2024, and they were divided into TACE+D and TACE+D+C groups. PSM was used to perform 1:1 matching (58 patients per group). Tumor response, progression-free survival (PFS), overall survival (OS), and treatment-related adverse events (TRAEs) were compared; Cox regression was used to identify prognostic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After PSM, 58 patients were included in each group. Compared with the TACE+D group, the TACE+D+C group demonstrated a significantly higher partial response (PR) (37.93% vs 20.69%,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.041), objective response rate (ORR) (62.07% vs 36.21%,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.005) and disease control rate (DCR) (86.21% vs 70.69%,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.042). Notably, the TACE+D+C group achieved a remarkably longer mOS than the TACE+D group (23.1 months vs 12.0 months,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.022). Similarly, median PFS was significantly prolonged in the TACE+D+C group compared with the TACE+D group (13.0 months vs 7.8 months,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.007). Multivariable Cox regression identified Barcelona Clinic Liver Cancer (BCLC) stage (hazard ratio [HR] = 1.69,\n                      <jats:italic>P<\/jats:italic>\n                      =\u00a00.029), Protein Induced by Vitamin K Absence or Antagonist-II (PIVKA-II) (HR\u00a0=\u00a03.66,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001), and alpha-fetoprotein (AFP) level (HR\u00a0=\u00a02.38,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001) as independent prognostic factors for OS. For PFS, independent prognostic factors were PIVKA-II (HR\u00a0=\u00a03.07,\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt;\u00a00.001) and AFP level (HR\u00a0=\u00a02.52,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&amp;lt;\u00a00.001). Although the TACE+D+C group exhibited immune-related adverse events (irAEs) (e.g., hypothyroidism and reactive cutaneous capillary endothelial proliferation), no significant differences were observed between the two groups in drug-related TRAEs, TRAEs after TACE, or Grade 3 TRAEs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The TACE+D+C group significantly improves ORR, PFS and OS in uHCC patients with a comparable safety profile to the TACE+D group, while the single-center retrospective design limits generalizability, warranting prospective studies.<\/jats:p>\n                  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