Comparison of Transarterial Chemoembolization vs Radioembolization for Large Unresectable Hepatocellular Carcinoma (>8cm): A Propensity Score Matching Analysis.

Abstract

Objective This study aimed to compare transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) as first-line treatments for unresectable HCC > 8 cm. Methods This retrospective study analyzed 129 HCC patients with tumor diameters greater than 8 cm from January 2010 to December 2021, including 40 patients who received TARE and 89 patients treated with TACE as primary treatment. Following Propensity Score Matching (PSM), 40 patients from each group were harmonized for baseline characteristics. Tumor responses were evaluated using mRECIST criteria, and survival outcomes were compared between treatment groups using Kaplan-Meier curves and the Log-rank test. Results There was no significant difference in the objective response rate (ORR) and disease control rate (DCR) at 3, 6, and 12 months between the two groups; ORR and DCR were 72.6%, 83.1% in TACE group vs 72.5%. 87.5% in TARE group for best tumor response (p-values: 0.625 and 0.981, respectively). Overall survival (OS) and progression-free survival (PFS) between the two groups were comparable pre- and post-PSM. After PSM, the OS was 33.2 months (20.0-58.6) in TACE group and 38.1 months (13.8–98.1) in TARE group (p = 0.53), while PFS was 11.5 months (7.7–18.4) and 9.1 months (5.2–23.8) respectively. After PSM, post-embolization syndrome developed more in TACE group (100% vs. 75%, p = 0.002). Major adverse events were 72% in TACE group vs. 5% in TARE group (p < 0.001). Conclusions TARE and TACE offer comparable efficacy in managing large HCC, with TARE providing a safer profile, suggesting its consideration as a preferable initial therapeutic approach for unresectable HCC patients with tumors larger than 8 cm.