Transarterial Radioembolization Versus Transarterial Chemoembolization in Elderly Patients (≥75 Years) With Hepatocellular Carcinoma: A Propensity Score-Matched Comparison

Objective: To compare the efficacy and safety of transarterial radioembolization (TARE) with those of transarterial chemoembolization (TACE) in elderly patients (≥75 years) with hepatocellular carcinoma (HCC). Materials and Methods:This retrospective study included 319 treatment-naïve elderly patients (≥75 years) with HCC who underwent TARE (n = 55) or TACE (n = 264) between November 2021 and November 2025.Propensity score matching (1:1) was performed to balance the baseline characteristics, yielding 55 matched patient pairs.The treatment response, time to local tumor progression (TTLTP), time to progression (TTP), overall survival (OS), adverse events, and length of hospital stay were compared.Results: After matching, the baseline characteristics were well balanced between the two groups.The complete response rate was marginally higher in the TARE group (54.5% vs. 34.5%,P = 0.055).TARE was associated with a significantly longer TTLTP (hazard ratio [HR] with TACE as the reference category, 0.26; 95% confidence interval [CI], 0.10-0.71;P = 0.009); the median was not reached, compared with 18.5 months in the TACE group.No significant differences in TTP (HR, 1.07; 95% CI, 0.60-1.90;P = 0.812) or OS (HR, 1.35; 95% CI, 0.70-2.60;P = 0.376) were observed between the two groups.In the TARE group, mild-to-moderate abdominal pain occurred less frequently (5.5% vs. 21.8%,P = 0.024), severe adverse events were significantly less frequent (3.6% vs. 41.8%,P < 0.001), and hospital stays were shorter (median, 4 days vs. 6 days; P < 0.001).Conclusion: In elderly patients with HCC, TARE demonstrated a more favorable safety profile and better local tumor control, in a population enriched with patients typically considered for this procedure in clinical practice.Therefore, TARE may be preferentially considered over TACE for elderly patients with larger tumors or reduced physiological reserves.