The Efficacy and Safety of Donafenib Plus PD-1/L1 Monoclonal Antibodies Plus TACE or HAIC as First-line Treatment for Unresectable Hepatocellular Carcinoma A Multi-center, Retrospective Clinical Study

Inclusion criteria

• Patients with unresectable hepatocellular carcinoma (uHCC) who received donafenib, an anti-PD-1/L1 monoclonal antibody combined with transarterial interventional therapy (TACE or HAIC), with retrievable records in the hospital electronic information system between June 1, 2021 and November 30, 2024.
• Diagnosis of hepatocellular carcinoma confirmed by the Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2024 Edition) clinically or by histology/cytology.
• Age ≥18 years, regardless of sex.
• No prior systemic therapy before the administration of donafenib, anti-PD-1/L1 monoclonal antibody combined with transarterial interventional therapy (TACE or HAIC).
• The maximum interval between the initiation of donafenib, anti-PD-1/L1 monoclonal antibody, and transarterial interventional therapy (TACE or HAIC) does not exceed 8 weeks, and at the time the last of these treatment modalities is initiated, the subject must not have experienced disease progression.
• For patients who have previously undergone hepatectomy, the resection must be R0, and tumor recurrence must have occurred more than 24 months after surgery.
• At least one evaluable lesion (according to RECIST v1.1 criteria).
• Eastern Cooperative Oncology Group (ECOG) performance status (PS) score of 0 to 1.
• Child-Pugh class A or B.
• Adequate major organ function, defined by the following criteria:

Complete blood count (without blood transfusion or use of granulocyte colony-stimulating factor [G-CSF] within 14 days prior to screening):

• Hemoglobin ≥90 g/L;
• Absolute neutrophil count (ANC) ≥1.5×10⁹/L;
• Platelet count ≥75×10⁹/L;

• Blood biochemistry (without albumin use within 14 days prior to screening):
• Albumin ≥28 g/L;
• Total bilirubin ≤2× upper limit of normal (ULN);
• Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤5× ULN;
• Alkaline phosphatase (ALP) ≤5× ULN;
• Creatinine ≤1.5× ULN;

• Coagulation function:
• International normalized ratio (INR) or prothrombin time (PT) ≤1.5× ULN;
• Activated partial thromboplastin time (APTT) ≤1.5× ULN.

Exclusion criteria

• Incomplete or unavailable patient information data; patient refused follow-up or was lost to follow-up;
• Duration of donafenib, PD-1/L1 monoclonal antibody combined with transarterial intervention therapy was less than 1 month;
• Prior histologically/cytologically confirmed diagnosis of fibrolamellar hepatocellular carcinoma, sarcomatoid hepatocellular carcinoma, cholangiocarcinoma, or other components;
• History of malignancy other than hepatocellular carcinoma, unless meeting the following criteria: a) The patient received potentially curative treatment and there has been no evidence of disease for 5 years; b) Successfully treated resected cutaneous basal cell carcinoma, cutaneous squamous cell carcinoma, superficial bladder cancer, cervical carcinoma in situ, or other carcinoma in situ;