Transarterial Chemoembolization Versus Transarterial Radioembolization in Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis of Real-World and Clinical Trial Evidence

(1) Background: This systematic literature review (SLR) and meta-analysis evaluated the comparative clinical effectiveness and safety of transarterial radioembolization (TARE) versus transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). (2) Methods: Eligible studies were identified through an SLR following PRISMA guidelines using a predefined PICOS framework. PubMed and Embase were searched (2015-2025) for randomized controlled trials (RCTs) and observational studies comparing TARE and TACE. Meta-analyses were conducted for outcomes, including overall survival (OS), objective response rate (ORR), progression-free survival (PFS), and adverse events (AEs). Analyses were conducted for the overall population and predefined subgroups of interest. (3) Results: Among 1464 studies identified through database searches, 25 studies were selected for meta-analysis comprising 8146 patients with HCC. No significant difference was observed between TARE and TACE in 14 studies evaluating OS (HR: 0.99; 95% CI 0.70-1.39) or 13 studies evaluating ORR (RR: 0.94; 95% CI 0.84-1.05). Four studies reporting meta-analyzable PFS outcomes numerically favored TARE, although the difference was not statistically significant (HR: 0.54; 95% CI 0.29-1.01). Rates of any-grade and grade ≥3 AEs were comparable between the two arms. The results from subgroup analyses remained consistent with the overall findings. (4) Conclusions: TARE and TACE demonstrate comparable clinical outcomes in patients with HCC. Additional studies within specific, clinically meaningful subgroups of HCC patients will be valuable to further clarify the comparative effectiveness and safety of TARE and TACE in these populations.