Transarterial chemoembolization vs. bland embolization in hepatocellular carcinoma: real-world outcomes

Background: Transarterial chemoembolization (TACE) is the most frequently used treatment for intermediate-stage hepatocellular carcinoma (HCC); however, evidence supporting its superiority over bland transarterial embolization (TAE) is limited.Objective: To compare the effectiveness and liver-related complications of TACE and TAE using propensity score matching (PSM).Method: We retrospectively analyzed patients with HCC treated with first-line TACE or TAE at two referral centers between 2019 and 2021.Overall survival (OS) was the primary outcome.Predictors of OS were evaluated using a Cox proportional hazards model after PSM adjustment.Results: A total of 114 patients were included (73 TACE, 41 TAE).Most patients had advanced chronic liver disease, and 72.8% were Child-Pugh A. After a median follow-up of 17.9 months and PSM adjustment, no significant difference in OS was observed between TACE and TAE (HR 1.19; 95% CI 0.64-1.96;p = 0.69).On multivariate analysis, only the Child-Pugh score was independently associated with OS.Liver-related complications were comparable between groups (OR TACE vs. TAE 3.7; 95% CI 0.90-14.62;p = 0.06).Conclusions: After PSM, TACE and TAE show similar long-term survival and liver-related complication rates in patients with HCC.