A propensity score matching study on survival benefits of radiotherapy in patients with inoperable hepatocellular carcinoma

With the advancements in radiotherapy (RT) in recent years, several studies have shown that RT can significantly prolong the survival of patients with hepatocellular carcinoma (HCC). As a noninvasive treatment option, the application of RT for the treatment of HCC is garnering increasing attention. In this retrospective study, we included data from 13,878 patients with HCC from the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2019 and 325 patients with HCC treated in three tertiary hospitals in China between 2015 and 2021. Patient data were divided into RT and non-RT groups based on whether the patients underwent RT. Propensity score matching analysis was performed to minimize the deviation between the RT and non-RT groups, and the Kaplan-Meier method, Cox proportional hazard model, and nomogram were used to assess the efficacy of undergoing RT. The median overall survival (mOS) of the RT group was significantly longer compared with that of the non-RT group for the SEER data (16 months versus 9 months, p < 0.01). Similarly, the survival benefit was more significant in the RT group than in the non-RT group at our hospitals (34.1 months versus 15.4 months, p < 0.01). Furthermore, multivariate Cox analysis revealed that factors, including tumor (T) stage, patient age, tumor grade, serum AFP level, and chemotherapy, also affected patient survival. Moreover, these factors were also used to construct a nomogram. Subgroup analysis of these factors showed that RT was effective in prolonging patient survival in different populations. RT significantly improves the survival time of patients with inoperable HCC, thereby providing a basis for selecting HCC patients who can benefit from RT.