{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T12:03:48Z","timestamp":1788609828109,"version":"build-2803163510"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007129","name":"Natural Science Foundation of Shandong Province","doi-asserted-by":"publisher","award":["ZR2023QH127"],"award-info":[{"award-number":["ZR2023QH127"]}],"id":[{"id":"10.13039\/501100007129","id-type":"DOI","asserted-by":"publisher"}]}],"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, safety, and hepatic impact of TACE or HAIC plus lenvatinib with or without PD-1 inhibitors in unresectable hepatocellular carcinoma with high tumor burden (HTB-uHCC).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>This retrospective study (2019\u20132023) included 278 HTB-uHCC patients (defined as tumors exceeding the up-to-11 criteria or exhibiting Vp4 portal vein tumor thrombus) receiving either doublet therapy (TACE or HAIC + lenvatinib, THL) or triplet therapy (TACE or HAIC + lenvatinib + PD-1 inhibitor, THLP) (139 per cohort after 1:1 propensity score matching; caliper=0.2). Primary endpoints included overall survival (OS) and progression-free survival (PFS). Secondary endpoints comprised objective response rate (ORR), serial liver function tests, and adverse events (AEs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The THLP group demonstrated superior OS (median22.4 vs. 17.6 months, HR = 0.55, P &amp;lt; 0.001), PFS (13.5 vs. 8.5 months, HR = 0.53, P &amp;lt; 0.001), and ORR (72.7% vs. 52.5%, P &amp;lt; 0.001) compared to the THL group. No intergroup differences in albumin-bilirubin (ALBI) scores were observed at baseline or during months 1\u20135 (all P &amp;gt; 0.05). Both cohorts showed significant ALBI deterioration at progression versus baseline (P &amp;lt; 0.001). Child-Pugh stability at 6 months independently predicted ORR (adjusted OR 8.71, 95% CI 4.93\u201315.40; P &amp;lt;0.001). Grade 3\u20134 AEs occurred at comparable rates (46.8%vs. 43.2%,P=0.629), with no treatment-related deaths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Triplet therapy significantly improves survival and tumor response without accelerating early liver function decline in patients with HTB-uHCC. Child-Pugh stability correlates strongly with treatment efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1717797","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T06:38:44Z","timestamp":1771223924000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Retrospective analysis of transarterial chemoembolization or hepatic arterial infusion chemotherapy combined with lenvatinib with or without PD-1 inhibitor as first-line therapy for unresectable hepatocellular carcinoma with high tumor burden: a propensity score-matched study"],"prefix":"10.3389","volume":"17","author":[{"given":"Zhenfeng","family":"Li","sequence":"first","affiliation":[{"name":"Department of Intervention Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, Shandong, 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