To evaluate the effectiveness and safety of transarterial chemoembolization (TACE) combined with tislelizumab and lenvatinib in patients with intermediate-to-advanced hepatocellular carcinoma (HCC) in real-world clinical practice.

Patients with intermediate-to-advanced HCC who received TACE combined with tislelizumab and lenvatinib at the Affiliated Hospital of Southwest Medical University from September 2021 to December 2023 were retrospectively enrolled. Overall survival (OS) and progression-free survival (PFS) were assessed using the Kaplan-Meier method. Secondary efficacy endpoints included objective response rate (ORR) and disease control rate (DCR). Safety was evaluated based on the incidence of adverse events (AEs), with a focus on grade ≥ 3 AEs.

By July 2025, 52 patients were included. The median follow-up time was 15 months, with median OS of 19.2 months and median PFS of 9.5 months. The best overall responses were as follows: complete response (CR) in 4 patients (7.7%), partial response (PR) in 15 patients (28.8%), stable disease (SD) in 25 patients (48.1%), and progressive disease (PD) in 8 patients (15.4%). The ORR was 36.5%, and the DCR was 84.6%. AEs of any grade occurred in 37 patients (71.2%), while grade ≥ 3 AEs were observed in 30.7% (16/52) of patients. No grade 4/5 AEs were reported. Univariate analysis indicated that tumor diameter and direct bilirubin (DBil) levels were associated with OS, while tumor diameter, DBil, and indirect bilirubin (IBil) levels were associated with PFS. Multivariate Cox regression analysis identified tumor diameter as an independent risk factor for OS (HR = 1.112; P = 0.031), and DBil level as an independent risk factor for PFS (HR = 2.453; P = 0.039).

In real-world practice, TACE combined with tislelizumab and lenvatinib demonstrated significant clinical benefits (median OS 19.2 months, median PFS 9.5 months, DCR 84.6%) with a manageable safety profile (grade ≥ 3 AE rate 30.7%, no grade 4/5 AEs). Tumor diameter was an independent risk factor for OS, and DBil level was an independent risk factor for PFS.