Cancer poses a threat to the health of many individuals. Among various types of cancer, LC is considered the most dangerous because it often presents no symptoms, and patients are typically diagnosed at an advanced stage. Additionally, in China, LC accounts for half of the global incidence, with over 70% of patients being diagnosed in the middle to late stages [26]. This phenomenon makes LC even more frightening. LC refers to malignant tumors that originate in or spread to the liver. Symptoms of LC include a lump or pain in the lower right side of the ribcage, ascites, jaundice, easy bruising, weight loss, and overall weakness [27]. The primary causes of LC are hepatitis B, hepatitis C, and alcohol-induced cirrhosis. Other causes include aflatoxin, non-alcoholic fatty liver disease, and liver fluke infection. In China, LC is prevalent, and most patients are diagnosed in the middle to late stages, losing the opportunity for surgical intervention. With advancements in medical technology, the available treatment options for LC have been rapidly evolving [28, 29]. Due to its insidious onset, atypical early symptoms, and diagnostic challenges, most patients with LC are already in the late stage or have distant metastasis at the time of diagnosis, with only about 15% of patients being suitable for surgical resection. For late-stage patients who have lost the opportunity for surgery, drug therapy becomes the main treatment approach. Even for those who can undergo surgical resection, postoperative recurrence is common, requiring adjuvant drug therapy [30]. However, treating LC is particularly challenging due to the presence of hepatitis, cirrhosis, and liver dysfunction in patients. Interventional treatments are effective but invasive and often limited in their application. Currently, there is no evidence to suggest that chemotherapy can prolong survival in LC, and there is a lack of universally recognized effective drugs and standardized regimens. As a result, late-stage patients often face the dilemma of having no effective treatment options and a poor prognosis. Currently, the main treatment methods for LC include surgery, liver transplantation, ablation therapy, interventional therapy, radiation therapy, chemotherapy, targeted therapy, and immunotherapy. Among these, targeted therapy acts like a missile, precisely attacking the tumor while minimizing harm to normal cells. Therefore, compared to chemotherapy, targeted therapy generally offers better control of ARs [31]. In this work, 100 patients with ALC admitted to the hospital from May 2020 to August 2022 were rolled into two groups using a random number table: 50 patients in the Obs group and 50 patients in the Ctrl group. The patients in the Ctrl group received TACE alone, while those in the Obs group received both TACE and oral sorafenib treatment. The balance of baseline data between the groups was ensured to guarantee comparability of the observed results of the dependent variables under similar baseline conditions, thereby examining the true impact of the intervention factors on the observed results. A comparison of the baseline characteristics between the two groups revealed no statistically great differences in age, gender, disease duration, BCLC stage, tumor diameter, cancer thrombus, or extrahepatic metastasis (P > 0.05). This provides feasibility for the subsequent comparison of data between the groups.

DCR refers to the proportion of patients whose tumors shrink or remain stable for a certain period of time, including complete remission, partial remission, and stabilization cases [32]. It was found that the DCR of patients in the Obs group (90%) was sharply higher than that in the Ctrl group (78%), showing a difference with P < 0.05. This indicates that the addition of sorafenib treatment on top of TACE has a significant short-term efficacy for patients with ALC, effectively inhibiting the occurrence and progression of tumors. The median STof patients in the Obs group was higher and the median DPT was lower, exhibiting substantial differences to those in the Ctrl group (P < 0.05). The median ST represents the time at which only 50% of individuals can survive beyond that duration. When evaluating the median survival time for a specific cancer type, it is generally calculated from the time of tumor detection. DPT refers to the time from randomization to objective tumor progression [33, 34]. Therefore, these results indicate that the addition of sorafenib treatment on top of TACE can effectively prolong the ST of patients with ALC and delay the progression of the disease.

The study of QOL in medical research has received high attention and has reached a high level of investigation, with widespread applications. The use of QOL measurements allows for the evaluation of the health status of populations and the QOL of patients with various diseases. It also helps assess the effectiveness of optimizing clinical treatment interventions and various preventive healthcare measures, as well as exploring factors influencing health and disease prevention priorities and participating in decision-making regarding the allocation and utilization of healthcare resources [35, 36]. In this work, the rate of improvement and stability in QOL for patients in the Obs group (78%) was higher, showing a remarkable difference to that in the Ctrl group (58%) (P < 0.05). This indicates that the addition of sorafenib treatment on top of TACE can effectively improve the QOL for patients with ALC. Immunity, also known as resistance, refers to the coordinated functioning of various systems in the human body under the control of the central nervous system to ensure the normal functioning of life activities [37]. The immune system is a crucial component of this coordination, with tissue barriers acting as the first line of defense of the immune system. Within the immune cells, CD4 + factors can secrete cellular tissue to enhance immune response and kill tumor cells, while CD8 + factors can secrete inhibitory cells to suppress CD4 + factors, inhibit B cell synthesis, and thereby inhibit immune response, resulting in decreased immune function [38]. This work compared immune function indicators between patients in different groups and found that the levels of CD3+, CD4+, and CD4+/CD8 + in patients in the Obs group after treatment were much higher, with P < 0.05 to the levels of these indicators in the Ctrl group. This suggests that the addition of sorafenib treatment on top of TACE can greatly enhance the immune capacity of patients with LC and improve their immune function [39]. Safety is a prerequisite for clinical drug use, and the basic principle is that drugs should not cause or only cause minor and acceptable ARs or side effects. For example, family planning drugs and drugs for infants and young children have high safety requirements, while drugs for life-threatening tumors and AIDS may allow for certain ARs [40]. As a multi-targeted molecular targeted drug, sorafenib, like other drugs, may have certain toxic and side effects, with gastrointestinal bleeding, rash, hypertension, hair loss, diarrhea, and HFS being the most common ones [41]. This work suggested that in the Obs group, there were 2 cases of mild fatigue, 1 case of liver pain, 1 case of HFS, 2 cases of diarrhea, and 2 cases of fever, with an incidence of ARs of 16%. In the Ctrl group, there were 3 cases of mild fatigue, 2 cases of liver pain, 3 cases of HFS, 2 cases of diarrhea, and 4 cases of fever, with an incidence of ARs of 28%. The incidence of ARs in the Obs and Ctrl groups presented an obvious difference (P < 0.05). This indicates that the addition of sorafenib treatment on top of TACE can effectively reduce the occurrence of ARs in patients and demonstrates its safety and feasibility.