TACE vs. TARE for HCC ≥ 8 cm: A propensity score analysis

Area of Science:

• Hepatobiliary oncology
• Interventional radiology
• Oncologic imaging and response assessment

Background:

• Hepatocellular carcinoma (HCC) larger than 8 cm presents a significant treatment challenge.
• First-line treatment options for unresectable HCC include transarterial chemoembolization (TACE) and transarterial radioembolization (TARE).
• Comparative data on the efficacy and safety of TACE versus TARE for large HCC is limited.

Purpose of the Study:

• To compare the efficacy and safety of TARE and TACE as first-line treatments for unresectable HCC tumors greater than 8 cm.
• To evaluate treatment response and survival outcomes between TACE and TARE groups.
• To assess the incidence of adverse events associated with each treatment modality.

Main Methods:

• Retrospective analysis of 129 patients with unresectable HCC > 8 cm treated between 2010-2021.
• Propensity Score Matching (PSM) was used to create comparable groups of 40 patients each for TARE and TACE.
• Tumor response assessed by mRECIST criteria; survival by Kaplan-Meier and Log-rank tests.

Main Results:

• No significant difference in objective response rate (ORR) or disease control rate (DCR) at 3, 6, and 12 months between TACE and TARE.
• Comparable overall survival (OS) and progression-free survival (PFS) post-PSM (OS: 33.2 months TACE vs. 38.1 months TARE; PFS: 11.5 months TACE vs. 9.1 months TARE).
• TARE group had significantly lower rates of post-embolization syndrome (75% vs. 100%) and major adverse events (5% vs. 72%) compared to TACE post-PSM.

Conclusions:

• TARE and TACE demonstrate comparable efficacy for unresectable HCC > 8 cm.
• TARE offers a superior safety profile compared to TACE in this patient cohort.
• TARE should be considered a preferable first-line therapeutic option for patients with large unresectable HCC.