Editor's Note: From October 23 to 27, 2026, the European Society for Medical Oncology (ESMO) Congress was held in Madrid, Spain. At this year's congress, numerous studies from China were selected for oral presentations, posters, and e-posters, demonstrating the growing presence of Chinese oncology research on the international stage. Although a wide range of treatment options is available for hepatocellular carcinoma (HCC), long-term survival data comparing different treatment strategies in real-world settings remain limited. A real-world study conducted by Professor Jing Feng's team at Shanxi Provincial People's Hospital was selected for e-poster presentation at this year's ESMO Congress. Addressing practical challenges in HCC diagnosis and treatment, the study used a large cohort with long-term follow-up to investigate key factors affecting patient survival, offering new insights into clinical risk stratification and individualized treatment.HCC is one of the most common malignancies worldwide. Its treatment strategies include surgical resection, locoregional interventional therapy, systemic anticancer therapy, and various combination approaches. However, in real-world clinical practice, large-scale studies with long follow-up periods comparing long-term survival outcomes and their influencing factors across different treatment modalities remain scarce.
A five-year regional real-world study (2020–2025) reported by the team at Shanxi Provincial People’s Hospital found that survival outcomes in patients with HCC may be influenced more by tumor biology and disease stage than by treatment strategy alone. These findings have important implications for clinical risk stratification.
Study Overview
Abstract Number: 1709eP
English Title: Nivolumab plus Ipilimumab with or without Interventional Therapy for Hepatocellular Carcinoma in Later-line Setting: A Real-World Study
Chinese Title: Nivolumab Plus Ipilimumab With or Without Interventional Therapy for Later-Line Treatment of Hepatocellular Carcinoma: A Real-World Study
Study Methods
This was a single-center, retrospective real-world cohort study designed to evaluate the impact of different treatment strategies on overall survival (OS) in patients with HCC. Patients diagnosed with HCC at Shanxi Provincial People’s Hospital were included and classified into three groups according to the treatments they actually received: interventional therapy alone, interventional therapy combined with systemic treatment, and systemic treatment alone. Long-term survival outcomes and independent prognostic factors were systematically compared across the three groups.
The primary endpoint was OS. Secondary endpoints included 1-, 2-, 3-, 4-, and 5-year OS rates, as well as independent prognostic factors associated with OS. The Kaplan–Meier method was used to estimate 1- to 5-year OS rates in each group and generate survival curves. Multivariable Cox proportional hazards regression was performed to evaluate the independent association between treatment modality and OS while adjusting for other prognostic covariates. The significance level was set at α=0.05.
Study Results
(1) Baseline Characteristics of the Enrolled Patients
A total of 293 patients with HCC were included. The median age was 63 years, and 72.0% were male. Overall, 80.2% of patients had BCLC stage B or C disease, and the median alpha-fetoprotein (AFP) level was 36.6 ng/mL.
Of the 293 patients, 115 received interventional therapy alone, 122 received interventional therapy combined with systemic treatment, and 56 received systemic treatment alone.
(2) Comparison of OS Across Treatment Groups
Survival analysis showed that median OS had not been reached (NR) in the interventional therapy-alone group. Median OS was 68.07 months in the interventional therapy plus systemic treatment group and 36.93 months in the systemic therapy-alone group. The 1-, 2-, 3-, 4-, and 5-year OS rates in the three groups are presented in Table 1.
Table 1. Comparison of Overall Survival Rates Across Different Treatment Groups
(3) Analysis of Independent Prognostic Factors
Multivariable Cox proportional hazards regression analysis showed that elevated AFP levels and advanced BCLC stage were independent adverse prognostic factors for OS in patients with HCC.
Higher AFP levels (log[AFP+1]; HR, 1.15; 95% CI, 1.03–1.27; P=0.009) were significantly associated with poorer survival. Advanced BCLC stage (stages C/D vs. stages other than C/D; HR, 1.96; 95% CI, 1.06–3.65; P=0.033) was also identified as an independent adverse prognostic factor.
Study Conclusions
The findings of this real-world study suggest that, in clinical practice, long-term survival outcomes in patients with HCC may depend more heavily on the biological characteristics of the tumor and disease stage than on the choice of a single treatment strategy. These findings underscore the importance of implementing precise risk stratification in routine clinical practice and provide valuable reference evidence for optimizing individualized treatment decisions in HCC.
Professor Jing Feng
