Post-TARE Survival Outcomes in Hepatocellular Carcinoma: Influence of Pre-TARE Immunotherapy and Targeted Therapy in a Real-World Cohort.

Background: Transarterial radioembolization (TARE) combined with systemic therapy has shown activity in unresectable hepatocellular carcinoma (HCC). However, the prognostic impact of different treatment exposures before TARE in real-world practice remains unclear. Methods: This single-center retrospective study included 71 patients with HCC who underwent TARE between November 2022 and August 2025. TARE was defined as the unified clinical landmark for outcome assessment. Patients were stratified according to treatment exposure before TARE: those who received ≥2 cycles of immune checkpoint inhibitors combined with targeted therapy prior to TARE (Group 1) and those who underwent TARE as the initial major treatment (Group 2). Progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) were evaluated. Cox regression analyses were performed to identify prognostic factors, including baseline neutrophil-to-lymphocyte ratio (NLR). Results: Group 2 achieved a significantly higher ORR than Group 1 (87.5% vs 56.4%, P = 0.004). Median PFS was significantly longer in Group 2 than in Group 1 (17.45 vs 4.86 months; hazard ratio = 0.327, 95% confidence interval: 0.125-0.856, P = 0.023). No significant difference in OS was observed during the current follow-up period. Patients with baseline NLR ≤3.28 experienced significantly prolonged PFS compared with those with NLR >3.28. Conclusion: In this real-world cohort, treatment exposure prior to TARE was associated with post-TARE PFS and tumor response, but not with OS. These findings suggest that baseline treatment history and systemic inflammatory status influence post-TARE prognosis, rather than indicating the superiority of a specific treatment sequence. Prospective studies with longer follow-up are warranted.