Abstract
The benefit of adding programmed cell death protein 1 (PD-1) blockade to hepatic arterial infusion chemotherapy (HAIC) plus lenvatinib for unresectable hepatocellular carcinoma remains uncertain. This single-center retrospective cohort study included 373 patients. After propensity score matching, 107 patients treated with HAIC plus lenvatinib alone and 107 patients treated with a PD-1 inhibitor were analyzed. Outcomes included overall survival (OS), progression-free survival (PFS), tumor response, and adverse events. PD-1 therapy was associated with longer OS (median, 22.5 vs 13.8 months; adjusted hazard ratio, 0.61; 95% CI, 0.40-0.94; p = 0.025) and a higher objective response rate (52.3% vs 40.2%, p = 0.075). The adjusted PFS difference was significant (hazard ratio, 0.67; 95% CI, 0.48-0.92; p = 0.015). No statistically significant differences in survival were detected among sintilimab, camrelizumab, and pembrolizumab. Grade 3-4 adverse events were comparable. Adding PD-1 blockade was associated with longer OS without substantially increasing severe toxicity.