Supplementary Material for: Impact of Procedural Quality on Outcomes of Transarterial Chemoembolization for Hepatocellular Carcinoma: A Multicenter Study

Objectives: Transarterial chemoembolization (TACE) is the primary treatment modality for intermediate-stage hepatocellular carcinoma (HCC). However, the lack of standardization to optimal technique leads to a wide variation in outcomes. This study aimed to evaluate the impact of procedure quality of TACE on HCC management. Materials and Methods: This multicenter retrospective cohort study included HCC patients with ≤4 tumors (maximum diameter ≤7 cm) treated with TACE monotherapy as first-line treatment between January 2009 and December 2022. Patients were classified into precision TACE and non-precision TACE groups based on adherence to predefined technical criteria encompassing angiography, catheterization, embolic agents, embolization endpoints, and assessment.The procedural quality further stratified using a scoring system (where points were deducted for technical deficiencies). The primary outcome was objective response rate (ORR) after first TACE (first-ORR) based on modified Response Evaluation Criteria in Solid Tumors. Secondary outcomes included overall ORR, progression-free survival (PFS), overall survival (OS), and safety profiles. Results: The analysis included 3059 patients (median age, 58.00 years [IQR: 49.00-66.00]; 2592 males [84.7%]) with 2286 patients included in precision TACE and 773 patients included in non-precision TACE group. First-ORR was 59.4% (1359/2286) in the precision TACE group versus 47.0% (363/773) in the non-precision TACE group (P