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69.2 % were male. Forty-four patients (56.4 %) experienced tumor progression with

time to progression 5.1 months (95% confidence interval (CI): 4.7-6.8) months. In

multivariate Cox regression analysis, albumin-bilirubin (ALBI) grade II (adjusted HR:

2.883, P=0.0104), and treatment duration less than three months (adjusted HR: 3.801,

P=0.0014) were the independent predictive factors for tumor progression. On the

other hand, patients achieving objective response under lenvatinib treatment was the

independent protective factor for tumor progression (adjusted HR: 0.144, P=0.0020).

Furthermore, there were twenty-six (59.1%) patients receiving subsequent

locoregional therapy after tumor progression. Among patients with tumor progression,

patients who received subsequent locoregional therapy showed significantly better

st
survival than those who did not receive following locoregional therapy (1 year

cumulative survival rate 70 % vs 27 %, log-rank P=0.003).

Conclusion:

ALBI grade, treatment duration of lenvatinib, and best image response were the

independent predictive factors for tumor progression. Furthermore, longer overall

survival was observed in tumor progression patients with subsequent locoregional

therapy.