Abstract: Objective To evaluate the efficacy of transarterial chemoembolization (TACE) combined with bevacizumab hepatic arterial infusion chemotherapy (HAIC) in patients with primary hepatocellular carcinoma (HCC), and to explore its effects on postoperative quality of life, tumor marker levels, as well as short- and long-term survival rates. Methods This prospective study enrolled 131 HCC patients treated at the First Affiliated Hospital of Heilongjiang University of Chinese Medicine from May 2019 to May 2022. Patients were divided into two groups: the TACE group (n=47) receiving TACE alone, and the combination group (n=84) receiving TACE preceded by bevacizumab HAIC. Efficacy and clinical benefit rates were compared between the two groups. Serum tumor marker levels were measured pre- and post-treatment. Tumor-related protein factors were analyzed before and 3 months after treatment. Quality of life was assessed using the Karnofsky Performance Status (KPS) score. Survival curves were generated during follow-up. Results Post-treatment serum levels of AFP, VEGF, CA125, CEA, CYFRA21-1, SCC, and CA50 in the combination group were significantly lower than those in the TACE group (P<0.05). The combination group showed higher PTEN expression and lower MUC1 expression (1.72±0.22 vs. TACE group) and HSP90α levels (45.31±2.94 ng/mL vs. TACE group, P<0.05). The combination group achieved higher KPS scores post-treatment (P<0.05). During follow-up, 79 patients survived in the combination group versus 35 in the TACE group. The combination group demonstrated significantly higher cumulative 2-year overall survival (OS: χ²=22.734, P<0.05) and progression-free survival (PFS: χ²=23.428, P<0.05) rates. Conclusion TACE combined with anti-VEGF monoclonal antibody (bevacizumab) HAIC significantly improves both short- and long-term prognoses in HCC patients. This synergistic regimen effectively reduces serum tumor markers such as AFP and enhances functional status (KPS), demonstrating superior survival benefits in OS and PFS. The combined modality represents a promising clinical strategy for HCC management.

Key words: Primary liver cancer, Transarterial chemoembolization, Bevacizumab, Hepatic arterial infusion chemotherapy, Survival analysis