Efficacy and Safety of Sequential Radiotherapy and Immune Checkpoint Inhibitors for Advanced Hepatocellular Carcinoma: A Single-Center PSM Retrospective Cohort Study.
5 affiliations
- 1Department of Oncology, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.
- 2Department of Oncology, The First People's Hospital of Liangshan Yi Autonomous Prefecture, Luzhou, Sichuan, People's Republic of China.
- 3Academician (Expert) Workstation of Sichuan Province, Luzhou, Sichuan, People's Republic of China.
- 4Clinical Research Center, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, People's Republic of China.
- 5Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, People's Republic of China.
Abstract
Background
The optimal administration sequence of immune checkpoint inhibitors (ICIs) and radiotherapy (RT) for advanced hepatocellular carcinoma (HCC) remains unclear. This study compared the efficacy and safety of ICIs administered before vs after RT in advanced HCC patients.Methods
This single-center, retrospective cohort study employed propensity score matching (PSM). Patients with advanced HCC receiving sequential ICI-RT therapy (with or without concurrent targeted therapy) from January 2020 to December 2024 were divided into ICI+RT (ICI before RT, n=96) and RT+ICI (RT before ICI, n=100) groups, with treatment interval ≤14 days. Approximately half of patients in each group received concurrent targeted agents. Primary endpoints were progression-free survival (PFS) and overall survival (OS); secondary endpoints included objective response rate (ORR), disease control rate (DCR), and treatment-related adverse events (TRAEs).Results
After 1:1 PSM, 77 paired patients were analyzed (median follow-up 19.4 months). The RT+ICI group demonstrated longer median PFS (7.8 vs 5.6 months, HR 1.551, 95% CI 1.038-2.317, p=0.031), higher ORR (74.0% vs 54.5%, p=0.019), and lower progressive disease rate as best response (0.0% vs 10.4%, p=0.006). Median OS showed numerical but non-significant improvement (14.1 vs 12.5 months, HR 1.112, 95% CI 0.746-1.657, p=0.600). Grade 3-4 thrombocytopenia was more frequent in RT+ICI (42.9% vs 20.8%, p=0.006). Longitudinal neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio changes suggested potential immune-priming effects of RT when administered before ICI.Conclusions
In this retrospective PSM cohort, RT followed by ICI was associated with improved PFS and tumor responses in advanced HCC, alongside manageable toxicity. These findings suggest potential value of RT as immune priming before ICI, though prospective validation is needed given the observational nature and single-center design of this study.
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BibTeX
@article{fan2026efficacy,
title = {{Efficacy and Safety of Sequential Radiotherapy and Immune Checkpoint Inhibitors for Advanced Hepatocellular Carcinoma: A Single-Center PSM Retrospective Cohort Study.}},
author = {Huaxi Fan and Rong Yu and Guishu Wu and Jing Zhang and Xiangyu Deng and Xiaolong Liu and Mingyue Rao and Kun He and Jianwen Zhang},
journal = {Journal of hepatocellular carcinoma},
year = {2026},
month = oct,
doi = {10.2147/jhc.s645600},
url = {https://europepmc.org/article/MED/42968863},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Efficacy and Safety of Sequential Radiotherapy and Immune Checkpoint Inhibitors for Advanced Hepatocellular Carcinoma: A Single-Center PSM Retrospective Cohort Study.
AU - Huaxi Fan
AU - Rong Yu
AU - Guishu Wu
AU - Jing Zhang
AU - Xiangyu Deng
AU - Xiaolong Liu
AU - Mingyue Rao
AU - Kun He
AU - Jianwen Zhang
PY - 2026
DA - 2026/10/28
JO - Journal of hepatocellular carcinoma
DO - 10.2147/jhc.s645600
UR - https://europepmc.org/article/MED/42968863
AB - Background The optimal administration sequence of immune checkpoint inhibitors (ICIs) and radiotherapy (RT) for advanced hepatocellular carcinoma (HCC) remains unclear. This study compared the efficacy and safety of ICIs administered before vs after RT in advanced HCC patients.Methods This single-center, retrospective cohort study employed propensity score matching (PSM). Patients with advanced HCC receiving sequential ICI-RT therapy (with or without concurrent targeted therapy) from January 2020 to December 2024 were divided into ICI+RT (ICI before RT, n=96) and RT+ICI (RT before ICI, n=100) groups, with treatment interval ≤14 days. Approximately half of patients in each group received concurrent targeted agents. Primary endpoints were progression-free survival (PFS) and overall survival (OS); secondary endpoints included objective response rate (ORR), disease control rate (DCR), and treatment-related adverse events (TRAEs).Results After 1:1 PSM, 77 paired patients were analyzed (median follow-up 19.4 months). The RT+ICI group demonstrated longer median PFS (7.8 vs 5.6 months, HR 1.551, 95% CI 1.038-2.317, p=0.031), higher ORR (74.0% vs 54.5%, p=0.019), and lower progressive disease rate as best response (0.0% vs 10.4%, p=0.006). Median OS showed numerical but non-significant improvement (14.1 vs 12.5 months, HR 1.112, 95% CI 0.746-1.657, p=0.600). Grade 3-4 thrombocytopenia was more frequent in RT+ICI (42.9% vs 20.8%, p=0.006). Longitudinal neutrophil-to-lymphocyte ratio and lymphocyte-to-monocyte ratio changes suggested potential immune-priming effects of RT when administered before ICI.Conclusions In this retrospective PSM cohort, RT followed by ICI was associated with improved PFS and tumor responses in advanced HCC, alongside manageable toxicity. These findings suggest potential value of RT as immune priming before ICI, though prospective validation is needed given the observational nature and single-center design of this study.
SN - 2253-5969
ER -