This study develops and validates a prognostic model for patients with unresectable hepatocellular carcinoma treated with transcatheter arterial chemoembolization plus lenvatinib.

• Identified nine key risk factors impacting overall and progression-free survival, including tumor number and extrahepatic metastases.
• Survival prediction model showed area under the curve values of 0.706 at 3 years for overall survival and 0.702 for progression-free survival.

Surgeons can use this model to guide clinical decisions and optimize patient selection for this therapy.

• Triple therapy was a notable protective factor for survival outcomes.