Abstract: Objective This aimed to investigate clinical effectiveness of transhepatic arterial chemoembolization (TACE) in combination with targeted and immunotherapy plus Huai’er granule, an herbal compound, in the treatment of patients with unresectable primary liver cancer (PLC ). Methods 78 patients with unresectable PLC were admitted to our hospital between June 2022 and June 2024, and were divided into control (n=38) and observation (n=40) groups. All patients in the two groups received TACE in combination with targeted and immunotherapy, and those in the observation group received additionally Huai’er granules for six circles. All patients were followed-up until September 2025, and objective response rate (ORR) and disease control rate (DCR) were recorded. Serum des-γ-carboxy prothrombin (DCP), α-L-fucosidase (AFU) and alpha-fetoprotein (AFP) levels were routinely detected. Results ORR in the observation group was 45.0%, much higher than 21.1%(P＜0.05)in the control, while there was no significant difference as respect to DCR(80.0% vs. 60.5%) between the two groups (P>0.05); after treatment, serum DCP, AFU and AFP levels in the observation group were (95.3±23.4)mAU/mL, (67.9±20.9)U/L and (231.8±78.9)ng/mL, all much lower than [(121.5±25.7)mAU/mL, (111.5±18.2)U/L and (368.5±85.7)ng/mL, respectively, P＜0.05] in the control; β2-MG level was (0.6±0.1)mg/L, much lower than [(0.9±0.1)mg/L,P＜0.05], while eGFR was (108.8±11.9)mL/min /1.73m²,much higher than [(90.9±11.3)mL/min /1.73m²,P＜0.05] in the control; by end of follow-up, survival rate was 62.5%,much higher than 39.5%(x²=4.136,P=0.042)in the control; OS was (10.4±0.3)mon, and PFS was (9.5±0.5)mon, both much longer than [(8.3±0.5)mon and (7.6±0.6)mon, respectively, Log-Rank x²=6.970,P=0.008; x²=5.651,P=0.017] in the control. Conclusion Oral Huai’er granule at base of TACE and targeted and immunotherapy in dealing with unresectable PLC might protect hepatic and renal functions, and the clinical survival benefits needs further observation.

Key words: Hepatoma, Unresectable, Transhepatic arterial chemoembolization, Targeted, Immunotherapy, Huai’er granule, herbal medicine, Therapy