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Peer-reviewedCC BY 4.0Frontiers in Immunology

Efficacy and safety of sintilimab plus bevacizumab with or without transarterial chemoembolization for unresectable hepatocellular carcinoma: a propensity score-matched retrospective cohort study

  • Zizhuo Wang1,2,3
  • Bailu Wu1,2,3
  • Chunshu Wu1,2,3
  • Hongquan Wu1,2,3
  • Shihao Zhao1,2,3
  • Shuwen Ye1,2,3
  • Xiaodong Li1,2,3
  • Pengchao Zhan4
  • Xin Li1,2,3
  • Zhen Li1,2,3
4 affiliations
  1. 1Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University
  2. 2Henan Provincial Minimally Invasive Interventional Tumor Engineering and Technology Research Center
  3. 3Key Laboratory of Innovative and Translational Interventional Oncology Technology in Zhengzhou
  4. 4Department of Radiology, Third People’s Hospital of Henan Province
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Abstract

Background: To compare the efficacy and safety of transarterial chemoembolization (TACE) plus sintilimab and bevacizumab (triple therapy) versus sintilimab and bevacizumab alone (dual therapy) in unresectable hepatocellular carcinoma (uHCC).

Methods: This single-center retrospective cohort study enrolled consecutive patients with uHCC who received triple or dual therapy between October 2021 and May 2025. Propensity score matching (PSM) was performed using logistic regression (1:1 nearest-neighbor, caliper: 0.02 SD). The primary endpoint was progression-free survival (PFS). The secondary endpoints included objective response rate (ORR), disease control rate (DCR), overall survival (OS), and safety. An exploratory prognostic score for PFS was developed in the matched cohort and used to define risk strata for hypothesis-generating analyses.

Results: After PSM, 40 patients were included in each group. The triple therapy group achieved a longer median PFS than the dual-therapy group (13.11 vs. 8.57 months; log-rank P = 0.026). The median OS was not reached (log-rank P = 0.20). The ORR (75.0% vs. 60.0%; P = 0.233), DCR (95.0% vs. 82.5%; P = 0.154), and radiographic downstaging rate (17.5% vs. 5.0%; P = 0.154) were numerically higher with triple therapy. The prognostic model demonstrated that, median PFS was 14.46 months, 11.50 months, and 5.62 months in the low-, intermediate-, and high-risk groups, respectively (log-rank P < 0.001). Risk-stratified HR estimates were numerically lowest in the intermediate-risk group; however, the formal treatment-by-risk-group interaction was not statistically significant ( P for interaction = 0.879). Grade 3–4 adverse events were numerically more frequent with triple therapy (37.5% vs. 22.5%; P = 0.222), with no treatment-related deaths.

Conclusions: In PSM-matched uHCC patients, TACE plus sintilimab-bevacizumab was associated with longer PFS, with generally manageable toxicity but a numerically higher incidence of grade 3–4 adverse events. Exploratory risk-stratified analyses generated hypotheses regarding potential differences in treatment benefit across prognostic strata.

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Cite

BibTeXRIS
BibTeX
@article{wang2026efficacy,
  title = {{Efficacy and safety of sintilimab plus bevacizumab with or without transarterial chemoembolization for unresectable hepatocellular carcinoma: a propensity score-matched retrospective cohort study}},
  author = {Zizhuo Wang and Bailu Wu and Chunshu Wu and Hongquan Wu and Shihao Zhao and Shuwen Ye and Xiaodong Li and Pengchao Zhan and Xin Li and Zhen Li},
  journal = {Frontiers in Immunology},
  year = {2026},
  month = oct,
  doi = {10.3389/fimmu.2026.1928849},
  url = {https://www.frontiersin.org/articles/10.3389/fimmu.2026.1928849/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Efficacy and safety of sintilimab plus bevacizumab with or without transarterial chemoembolization for unresectable hepatocellular carcinoma: a propensity score-matched retrospective cohort study
AU  - Zizhuo Wang
AU  - Bailu Wu
AU  - Chunshu Wu
AU  - Hongquan Wu
AU  - Shihao Zhao
AU  - Shuwen Ye
AU  - Xiaodong Li
AU  - Pengchao Zhan
AU  - Xin Li
AU  - Zhen Li
PY  - 2026
DA  - 2026/10/26
JO  - Frontiers in Immunology
DO  - 10.3389/fimmu.2026.1928849
UR  - https://www.frontiersin.org/articles/10.3389/fimmu.2026.1928849/full
AB  - Background: To compare the efficacy and safety of transarterial chemoembolization (TACE) plus sintilimab and bevacizumab (triple therapy) versus sintilimab and bevacizumab alone (dual therapy) in unresectable hepatocellular carcinoma (uHCC).  Methods: This single-center retrospective cohort study enrolled consecutive patients with uHCC who received triple or dual therapy between October 2021 and May 2025. Propensity score matching (PSM) was performed using logistic regression (1:1 nearest-neighbor, caliper: 0.02 SD). The primary endpoint was progression-free survival (PFS). The secondary endpoints included objective response rate (ORR), disease control rate (DCR), overall survival (OS), and safety. An exploratory prognostic score for PFS was developed in the matched cohort and used to define risk strata for hypothesis-generating analyses.  Results: After PSM, 40 patients were included in each group. The triple therapy group achieved a longer median PFS than the dual-therapy group (13.11 vs. 8.57 months; log-rank P = 0.026). The median OS was not reached (log-rank P = 0.20). The ORR (75.0% vs. 60.0%; P = 0.233), DCR (95.0% vs. 82.5%; P = 0.154), and radiographic downstaging rate (17.5% vs. 5.0%; P = 0.154) were numerically higher with triple therapy. The prognostic model demonstrated that, median PFS was 14.46 months, 11.50 months, and 5.62 months in the low-, intermediate-, and high-risk groups, respectively (log-rank P < 0.001). Risk-stratified HR estimates were numerically lowest in the intermediate-risk group; however, the formal treatment-by-risk-group interaction was not statistically significant ( P for interaction = 0.879). Grade 3–4 adverse events were numerically more frequent with triple therapy (37.5% vs. 22.5%; P = 0.222), with no treatment-related deaths.  Conclusions: In PSM-matched uHCC patients, TACE plus sintilimab-bevacizumab was associated with longer PFS, with generally manageable toxicity but a numerically higher incidence of grade 3–4 adverse events. Exploratory risk-stratified analyses generated hypotheses regarding potential differences in treatment benefit across prognostic strata.
SN  - 1664-3224
ER  -