Impact of body mass index in patients with hepatocellular carcinoma treated with TACE combined with lenvatinib and PD-1 inhibitors

Abstract Objectives It is unclear how body mass index (BMI) affects individuals with hepatocellular carcinoma (HCC) receiving lenvatinib and programmed death receptor 1 (PD-1) inhibitors and transcatheter arterial chemoembolization (TACE). This study aims to evaluate the impact of BMI on the efficacy and safety of TACE with systemic therapies in HCC patients. Methods A retrospective analysis was performed involving 102 patients receiving TACE alongside lenvatinib and PD-1 inhibitors. Key endpoints, including overall survival (OS) and progression-free survival (PFS), were analyzed, comparing overweight (BMI≥24 kg/m 2 ) and non-overweight (BMI<24 kg/m 2 ) individuals. Prognostic variables for OS and PFS were identified through Cox regression analyses (univariable and multivariable). The nonlinear association between mortality risk and BMI was evaluated using the RCS curve. A subgroup analysis was conducted to determine whether diabetes affects the survival of HCC patients in various BMI groups. Results The overweight group showed longer median OS (23.82 vs. 12.45 months, p=0.028) and median PFS (15.01 vs. 10.02 months, p=0.035) than the non-overweight group. Multivariable Cox analysis revealed that being overweight was a protective prognostic factor for OS and PFS. A U-shaped correlation between BMI and mortality risk was identified, with the risk reaching its nadir at a BMI of 24.13–26.37 kg/m 2 . However, the study’s retrospective design and small sample size limit the generalizability of these findings. Conclusion Being overweight was related to improved OS and PFS in HCC patients receiving TACE plus lenvatinib and PD-1 inhibitors. In individuals with HCC, a BMI between 24.13 and 26.37 is protective for OS.