Abstract: Objective To investigate the impact of scheduled hepatoprotective therapy on survival outcomes in lenvatinib-based treatment advanced hepatocellular carcinoma (HCC) patients with and Child-Pugh B (CP-B) cirrhosis. Methods A total of 48 patients diagnosed with advanced HCC and CP-B cirrhosis between April 2019 and April 2024 were retrospectively enrolled and divided into two groups: the hepatoprotection group (n=33, receiving polyene phosphatidylcholine combined with monoammonium glycyrrhizinate-cysteine) and the non-hepatoprotection group (n=17). Median survival time (MST), overall survival (OS), and survival rates were compared between the two groups. Subgroup analyses were performed based on imaging characteristics (portal vein tumor thrombus [PVTT] vs. extrahepatic metastasis) and treatment regimens (lenvatinib±TACE/PD-1). Results The hepatoprotection group demonstrated superior survival outcomes, with MST of 18 months (versus 7 months) and OS of 22 months (versus 8 months) compared to controls (both P<0.01). Survival rates at 6, 12, and 24 months were 90.32%, 70.97%, and 29.03% respectively in the hepatoprotection group, significantly higher than those in the non-hepatoprotective group (70.05%, 17.64%, and 0%, P<0.01). Subgroup analysis revealed comparable survival benefits regardless of tumor extension pattern (portal invasion versus distant metastases). Notably, combination therapies incorporating hepatoprotection showed consistently better outcomes across all regimens, with particular benefit observed in the lenvatinib plus TACE and PD-1 inhibitor subgroup (1-year survival 100% versus 50% in unprotected patients). Conclusion Scheduled hepatoprotective therapy significantly prolongs survival, improves survival rates, and enhances quality of life lenvatinib-treated advanced HCC patients with Child-Pugh B cirrhosis.

Key words: Monoammonium glycyrrhizinate-cysteine, Polyene phosphatidylcholine, Child-Pugh B cirrhosis, Advanced hepatocellular carcinoma, Lenvatinib, Survival time, Survival rate