摘要Background:Transarterial chemoembolization(TACE)based neoadjuvant therapy was proven effective in hepatocellular carcinoma(HCC).Recently,tyrosine kinase inhibitors(TKIs)and immune checkpoint in-hibitors(ICIs)also showed promise in HCC treatment.However,the prognostic benefits associated with these treatments remain uncertain.This study aimed to explore the relationship between pathologic re-sponse and prognostic features in HCC patients who received neoadjuvant therapy.Methods:HCC patients who received TACE either with or without TKIs/ICIs as neoadjuvant therapy before liver resection were retrospectively collected from the First Affiliated Hospital,Zhejiang University School of Medicine in China.Pathologic response was determined by calculating the proportion of non-viable area within the tumor.Major pathologic response(MPR)was defined as the presence of non-viable tumor cells reaching a minimum of 90％.Complete pathologic response(CPR)was characterized by the absence of viable cells observed in the tumor.Results:A total of 481 patients meeting the inclusion criteria were enrolled,with 76 patients(15.8％)achieving CPR and 179(37.2％)reaching MPR.The median recurrence-free survival(mRFS)in the CPR+MPR group was significantly higher than the non-MPR group(31.3 vs.25.1 months).The difference in 3-year overall survival(OS)rate was not significant.Multivariate Cox regression analysis identified fail-ure to achieve MPR(hazard ratio=1.548,95％confidence interval:1.122-2.134;P=0.008),HBsAg pos-itivity(HR=1.818,95％CI:1.062-3.115,P=0.030),multiple lesions(HR=2.278,95％CI:1.621-3.195,P＜0.001),and baseline tumor size＞5 cm(HR=1.712,95％CI:1.031-2.849,P=0.038)were inde-pendent risk factors for RFS.Subgroup analysis showed that 67 of 93(72.0％)patients who received the combination of TACE,TKIs,and ICIs achieved MPR+CPR.Conclusions:In individuals who received TACE-based neoadjuvant therapy for HCC,failure to achieve MPR emerges as an independent risk factor for RFS.Notably,the combination of TACE,TKIs,and ICIs demonstrated the highest rate of MPR.