Comparison of Transarterial Chemoembolization vs Radioembolization for Large Unresectable Hepatocellular Carcinoma (>8cm): A Propensity Score Matching Analysis.

Comparison of Transarterial Chemoembolization vs Radioembolization for Large Unresectable Hepatocellular Carcinoma (>8cm): A Propensity Score Matching Analysis. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparison of Transarterial Chemoembolization vs Radioembolization for Large Unresectable Hepatocellular Carcinoma (>8cm): A Propensity Score Matching Analysis. Nhan Hien Phan, Ho Jong Chun, Jung Suk Oh, Su Ho Kim, Byung Gil Choi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4603096/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Sep, 2024 Read the published version in Abdominal Radiology → Version 1 posted 12 You are reading this latest preprint version Abstract Objective This study aimed to compare transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) as first-line treatments for unresectable HCC > 8 cm. Methods This retrospective study analyzed 129 HCC patients with tumor diameters greater than 8 cm from January 2010 to December 2021, including 40 patients who received TARE and 89 patients treated with TACE as primary treatment. Following Propensity Score Matching (PSM), 40 patients from each group were harmonized for baseline characteristics. Tumor responses were evaluated using mRECIST criteria, and survival outcomes were compared between treatment groups using Kaplan-Meier curves and the Log-rank test. Results There was no significant difference in the objective response rate (ORR) and disease control rate (DCR) at 3, 6, and 12 months between the two groups; ORR and DCR were 72.6%, 83.1% in TACE group vs 72.5%. 87.5% in TARE group for best tumor response (p-values: 0.625 and 0.981, respectively). Overall survival (OS) and progression-free survival (PFS) between the two groups were comparable pre- and post-PSM. After PSM, the OS was 33.2 months (20.0-58.6) in TACE group and 38.1 months (13.8–98.1) in TARE group (p = 0.53), while PFS was 11.5 months (7.7–18.4) and 9.1 months (5.2–23.8) respectively. After PSM, post-embolization syndrome developed more in TACE group (100% vs. 75%, p = 0.002). Major adverse events were 72% in TACE group vs. 5% in TARE group (p < 0.001). Conclusions TARE and TACE offer comparable efficacy in managing large HCC, with TARE providing a safer profile, suggesting its consideration as a preferable initial therapeutic approach for unresectable HCC patients with tumors larger than 8 cm. Large Hepatocellular Carcinoma Transarterial Chemoembolization Radioembolization Figures Figure 1 Figure 2 Figure 3 KEY POINTS Patients with Hepatocellular Carcinoma (HCC) larger than 8cm, ineligible for surgical resection, require effective and safe alternative treatments. TARE and TACE show similar outcomes in tumor response, overall survival (OS), and progression-free survival (PFS), with TARE leading to shorter hospital stays and fewer severe complications. TARE offers a suitable and safe alternative for patients with large (>8cm) HCC. INTRODUCTION Hepatocellular carcinoma (HCC) is a major contributor to global cancer-related mortality. Despite significant progress in early detection and management of risk factors, a substantial portion of cases are diagnosed with large HCC (> 8cm), posing dilemmas in treatment strategies. Surgical resection, advocated in various guidelines for large HCC, has been shown to provide superior survival benefits compared to other treatments [ 1 , 2 ]. However, the risk of postoperative liver failure, as well as common occurrences in patients with large HCC, such as vascular invasion, intrahepatic spread, and compromised liver function, significantly limit the number of patients eligible for surgery [ 3 ]. Consequently, alternative treatment modalities must be considered. Transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) are considered leading alternative treatments for patients with unresectable HCC. However, the efficacy of TACE is often limited when treating large tumors due to the presence of extensive extrahepatic collateral circulation and a low rate of complete response [ 4 ]. Although superselective or selective techniques have optimized the use of embolic materials, the extensive use of Lipiodol can compromise liver function and exacerbate postembolization syndrome, increasing the risk of complications such as pulmonary embolism [ 5 , 6 ]. Miyayama et al. recommend the use of stepwise TACE sessions to achieve optimal tumor response while minimizing adverse effects [ 7 ]. TARE is widely used across various stages of HCC [ 8 ]. Notably, large vessel occlusion is rare post-TARE, resulting in fewer complications such as post-embolization syndrome compared to TACE [ 8 – 11 ]. According to Meerun et al., TARE has shown significant response rates in HCC cases with portal vein tumor thrombosis (PVTT) and multifocal disease [ 12 ]. In a specific study where a significant majority of patients had tumors larger than 8 cm, Kim et al. reported that the therapeutic efficacy of TARE was comparable to liver resection [ 13 ]. However, large HCCs often exhibit a high lung shunt fraction and numerous extrahepatic branches, elevating the risk of radiation pneumonitis or adjacent organ damage post-TARE [ 14 , 15 ]. Consequently, the Barcelona Clinic Liver Cancer (BCLC) staging system recommends TARE primarily for HCC patients with single lesions smaller than 8 cm [ 16 ]. The era of immunotherapy, highlighted by the positive outcomes from the combination of Atezolizumab and Bevacizumab, has transformed the treatment landscape for hepatocellular carcinoma, particularly in advanced-stage HCC [ 17 ]. However, the effectiveness of these therapies in patients with large HCC tumors and high tumor burdens remains unproven [ 17 , 18 ]. Thus, local therapy such as TARE and TACE retain a crucial role in contemporary clinical settings [ 19 ]. This study aims to assess the safety and efficacy of TACE versus TARE in the management of patients with large HCC exceeding 8 cm. MATERIALS & METHODS Patient selection A retrospective study was approved by our hospital’s Institutional Review Board and patient consent was waived due to the study design. The study included all HCC patients with a tumor size larger than 8 cm who were treated with either TACE or TARE from January 2010 to December 2020 meeting the following criteria: (1) TACE or TARE as the initial treatment choice; (2) maximum diameter of the tumor exceeding 8 cm; (3) age ≥ 18 years; (4) Eastern Cooperative Oncology Group performance status 1 or 2; (5) Child-Pugh score of A or B (7 points). Exclusion criteria were as follows: (1) patients who received prior treatments such as liver resection, RFA, systemic therapy, or hepatic arterial infusion chemotherapy (HAIC); (2) age < 18 years; (3) having another malignant disease or a history of malignancy within 5 years from the start of treatment. All patients were diagnosed with HCC based on the American Association for the Study of Liver Diseases criteria [ 20 ]. (Fig. 1 ) Procedure The procedure was performed by three interventional radiologists with over ten years of experience in treating HCC using TARE and TACE. The choice of treatment method was based on discussions between the physician and the patient, considering the availability and cost of the technique. TARE procedure. Prior to commencing the TARE procedure, planning and dosimetry calculation were undertaken following the injection of Technetium-99m macroaggregated albumin into the hepatic artery. After this, single-photon emission computed tomography (SPECT/CT) imaging was employed to evaluate specific parameters. Quantitative metrics such as the hepatopulmonary shunt fraction (HSF) and the uptake ratio between the tumor and liver parenchyma were determined. This protocol incorporated a comprehensive assessment of the tumor-feeding arteries, in addition to the extrahepatic collaterals. Extrahepatic collateral arteries were embolized with coils or microspheres before performing TARE. TARE utilizes Yttrium-90 (Y90), which can be loaded onto either glass microspheres (TheraSphere®) or resin microspheres (SIR-Spheres®). The selection of the target lobe, segment, or subsegment is based on preprocedural imaging and tumor distribution. The dosage of Y90 is determined based on preprocedural CT hepatic arteriography (CTHA) and CT portography (CTPA) imaging, following the manufacturer’s guidelines [ 21 , 22 ]. This ensures that the pulmonary dose does not exceed 20 Gy and the liver parenchyma dose remains under 70 Gy (40 Gy for single-dose Y90 to compromised liver), while simultaneously optimizing the tumor dose to achieve the most favorable tumor response [ 23 ]. Patients with an HSF greater than 20% were not considered candidates for TARE. Patients with an HSF between 10% and 20% had their doses adjusted to ensure the pulmonary dose remained within safe limits. [ 19 ]. Post-therapy dose distribution is evaluated using bremsstrahlung imaging with SPECT/CT immediately following the procedure [ 19 , 24 ]. TACE procedure The procedures were conducted under the guidance of Emboguide software (Syngo Embolization Guidance, Siemens, Frankenthal, Germany) using cone-beam CT imaging. Microcatheters, ranging from 1.6 Fr to 1.8 Fr (Progreat; Terumo, Tokyo, Japan, and Asahi; Asahi Intecc, Nagoya, Japan), were utilized to access tumor-feeding vessels employing either superselective or selective techniques. Both conventional transarterial chemoembolization (cTACE) and drug-eluting bead TACE (DEB-TACE) modalities were chosen based on availability. For cTACE, a dose of 50 mg of doxorubicin (Ildong, Seoul, Korea) was dissolved in contrast media (Visipaque 270; GE Healthcare, Waukesha, USA) and 15 ml of Lipiodol (Guerbet, Roissy, France). Tumor-feeding arteries were embolized using gelatin microparticles sized 150–350 µm (EG Gel, Engain, Gyeonggi, Korea). For DEB-TACE, drug-eluting beads (DC-Bead, Boston Scientific, Marlborough, MA, USA) sized 100–300 µm were used. A vial of DC-Bead was loaded with 50 mg of doxorubicin over 30–60 minutes. The loaded DC-Beads were then diluted with 20 ml of contrast agent (Visipaque 270) and 20 ml of normal saline, creating a 40 ml mixture. For DEB-TACE, the endpoint for occlusion of the feeding arteries was typically near stasis of the contrast media [ 25 , 26 ]. Subsequent treatment considerations The initial tumor response after TARE is typically assessed three months post-procedure, whereas for TACE, it is assessed after one month. It is crucial to promptly determine subsequent treatment options upon confirming the presence of residual tumor to achieve optimal tumor control. Depending on the tumor response, the extent of residual tumor mass, and hepatic function, the next chosen treatment modality may include TACE, systemic therapy, or hepatic arterial infusion chemotherapy (HAIC). Assessments Tumor response and survival outcomes Tumor response was assessed using the modified Response Evaluation Criteria in Solid Tumors (mRECIST) based on imaging either via contrast-enhanced CT or magnetic resonance imaging (MRI) at the 3, 6, and 12-month intervals. In this context, the overall response rate (ORR) was defined as the sum of both complete response (CR) and partial response (PR). The disease control rate (DCR) encompassed CR, PR, and stable disease (SD). The best tumor response referred to the most favorable tumor response recorded during treatment. Overall survival (OS) was calculated from the time the patient began receiving TACE or TARE treatment until the time of death. Progression-free survival (PFS) was calculated from the time the patient began receiving TACE or TARE treatment until disease progression or death, whichever occurred first. Adverse events Adverse events were recorded clinically and through laboratory tests based on common terminology criteria for adverse events, version 5.0. All adverse events that occurred during the post-procedure hospitalization period or that necessitated unplanned hospital admissions were documented. Laboratory abnormalities were recorded within one month following the procedure. We categorized these adverse events into minor (grades 1 and 2) and major with higher grades. The duration of hospital stay was calculated from the time the patient underwent TARE or TACE until discharge during this initial treatment course. Propensity score matching (PSM) To ensure comparability between the two treatment groups, TACE, and TARE, we employed PSM at a 1:1 ratio. The variables incorporated into the propensity model consisted of gender, age, Child-Pugh score, BCLC stage, maximum tumor size, tumor number, tumor location, tumor type, and PVTT with a caliper of 0.2. After this matching process, a comparative analysis between TACE and TARE was conducted using both pre-PSM and post-PSM datasets. Statistical analysis Descriptive statistics were used to summarize the data, with categorical variables presented as frequencies and proportions. Continuous variables adhering to a normal distribution were described using mean ± standard deviation (SD), while those not following normality were represented by median and interquartile range (IQR). The Chi-square test compared two categorical variables, with Fisher’s exact test employed as an alternative when more than 20% of expected values were below 5. Continuous variables were assessed using the independent T-test or Mann-Whitney U test, depending on their distribution. Survival outcomes were delineated using Kaplan-Meier curves and compared via the Log-rank test. Statistical significance was defined as a p-value less than 0.05. Analyses were conducted using IBM SPSS Statistics version 26 (IBM Corp, Armonk, NY, USA) and R 4.3.1. RESULTS Patient characteristics We enrolled 129 HCC patients with lesions exceeding 8 cm in diameter, meeting our study criteria. Among them, 40 patients underwent TARE while 89 received TACE. Both groups showed comparability in fundamental characteristics, including age, gender, Child-Pugh score, BCLC stage, tumor size, tumor type, PVTT presence, tumor markers, and baseline liver function tests. Notably, a significant disparity emerged regarding tumor location, with the TARE group exhibiting a higher frequency of single-lobe tumors compared to the TACE group (82.5% vs. 67%). This variance arose due to the deliberate avoidance of bilobar approaches in TARE, driven by concerns over potential liver function decline. Correspondingly, tumor numbers also differed significantly: 72.5% of TARE patients presented with a single tumor, whereas 47.2% of TACE patients had the same (p = 0.026). Additionally, median serum AST concentration was lower in the TARE group compared to the TACE group (53 ± 41 U/L vs 65 ± 22 U/L) respectively; p = 0.043). Propensity score matching (PSM) was employed to ensure balanced study cohorts, resulting in no statistically significant differences in primary characteristics between the two groups post-PSM. Among the TACE group after PSM, 4 patients (10%) underwent DEB-TACE, while 36 patients (90%) received cTACE (Table 1 ). Table 1 The baseline characteristics of all patients before and after PSM. Variable Before PSM After PSM TACE TARE P value TACE TARE P value N 89 (69.0) 40 (31.0) 60 40 (44.9) 49 (55.1) 18 (45.0) 22 (55.0) 0.995 19 (45.7) 21 (52.5) 18 (54.0) 22 (55.0) 0.823 Etiology HBV HCV Alcohol 31 (50.8) 3 (4.9) 27 (44.3) 20 (64.5) 3 (9.7) 8 (25.8) 0.197 21 (67.7) 2 (6.5) 8 (25.8) 20 (64.5) 3 (9.7) 8 (25.8) 1 Child-Pugh score A B 81 (91.0) 8 (9.0) 39 (97.5) 1 (2.5) 0.272 38 (95.0) 2 (5.0) 39 (97.5) 1 (2.5) 1 BCLC A B C 33 (37.1) 30 (33.7) 26 (29.2) 19 (47.5) 8 (20.0) 13 (32.5) 0.272 23 (57.5) 5 (12.5) 12 (30.0) 19 (47.5) 8 (20.0) 13 (32.5) 0.573 Maximum tumor size (cm) 8–10 cm > 10 cm 35 (39.3) 54 (60.7) 15 (37.5) 25 (62.5) 0.844 15 (37.5) 25 (62.5) 15 (37.5) 25 (62.5) 1 Tumor number 1 2–5 >5 42 (47.2) 33 (37.1) 14 (15.7) 29 (72.5) 7 (17.5) 4 (10.0) 0.026 29 (72.5) 9 (22.5) 2 (5.0) 29 (72.5) 7 (17.5) 4 (10.0) 0.632 Tumor Location Unilobar Bilobar 60 (67.4) 29 (32.6) 33 (82.5) 6 (17.5) 0.029 33 (82.5) 7 (17.5) 33 (82.5) 6 (17.5) 1 Tumor types Focal massive Infiltrative 63 (70.8) 26 (29.2) 32 (80.0) 8 (20.0) 0.272 31 (77.5) 9 (22.5) 32 (80.0) 8 (20.0) 0.785 PVTT Yes No 23 (25.8) 66 (74.2) 16 (40.0) 24 (60.0) 0.105 12 (30.0) 28 (70.0) 16 (40.0) 24 (60.0) 0.348 AFP ≤ 400 > 400 41 (46.1) 48 (53.9) 22 (55.0) 18 (45.0) 0.348 18 (45.0) 22 (55.0) 22 (55.0) 18 (45.0) 0.371 Bilirubin 0.68 ± 0.42. 0.58 ± 0.34 0.125 0.67 ± 0.54 0.58 ± 0.4 0.488 Albumin 3.61 ± 0.54 3.65 ± 0.45 0.683 3.69 ± 0.53 3.65 ± 0.45 0.734 AST 65 ± 22 53 ± 41 0.043 56 ± 34 53 ± 38 0.690 ALT 36 ± 24 37 ± 18 0.506 34 ± 21 37 ± 20 0.433 Curative Treatment. Liver resection Liver transplantation Subsequent treatment TACE HAIC Systemic therapy 6(6.7) 3(3.4) 72(80.9) 10(11.2) 7(7.9) 4(10) 2(4) 30(75) 5(12.5) 5(12.5) 0.625 0.671 2(5) 2(5) 35(87.5) 2(5) 3(7.5) 4(10) 2(4) 30(75) 5(12.5) 5(12.5) 0.744 0.338 HCC, hepatocellular carcinoma; PSM, propensity score matching; TARE, transarterial chemoembolization; TACE, transcatheter arterial chemoembolization; AFP, alpha-fetoprotein; PVTT: portal vein tumor thrombosis; PLT: platelet; AST: Aspartate aminotransferase; ALT: alanine aminotransferase; BCLC: Barcelona Clinic Liver Cancer; HAIC, hepatic artery infusion chemotherapy. Tumor response The tumor response at the 3-month, 6-month, and 12-month time points, as well as the best observed tumor response, are documented in Table 2 . The tumor response to both treatment modalities demonstrated minimal variation across most time intervals. However, at the 6-month juncture, TACE exhibited superior tumor control rates in terms of DCR (p = 0.003). The best tumor response between the two groups was comparable; patients treated with TACE had an ORR of 72.6%, while those treated with TARE had an ORR of 72.5%. Concurrently, the DCR for the two groups was 83.1% and 87.5%, respectively, (Table 2 ). Table 2 Comparison of post-PSM tumor response between groups treated with TACE and TARE. Tumor response (After PSM) N (%) 3 months (N = 78) 6 months (N = 68) 12 months (N = 54) Best tumor response (N = 78) TACE (n = 38) TARE (n = 40) p TACE (n = 31) TARE (n = 37) p TACE (n = 26) TARE (n = 28) p TACE (n = 38) TARE (n = 40) p CR 8(21.1) 2(5) - 13(41.9) 10(27) 0.626 12(46.2) 9(32.1) 0.438 14(36.8) 12(30) 0.506 PR 17(44.7) 23(57.5) 0.368 9(29) 14(40.5) 0.006 7(26.9) 8(28.6) 1 14(36.8) 17(42) 0.999 SD 7(18.4) 10(25) 0.668 5(16.1) 3(8.1) - 0 1(3.6) - 4(10) 6(15) - PD 6(15.8) 5(12.5) 0.927 4(12.9) 9(24.3) - 7(26.9) 10(35.7) 0.688 6(15.8) 5(12.5) 0.810 ORR 65.8% 62.5% 0.947 70.9% 67.5% 0.124 73.1% 60.7% 0.5 72.6% 72.5% 0.625 DCR 84.2% 87.5% 0.927 87% 75.6% 0.003 73.1% 64.3% 0.688 83.1% 87.5% 0.981 PSM, propensity score matching; TARE, transarterial chemoembolization; TACE, transcatheter arterial chemoembolization; CR, complete response; PR, partial response; SD, stable disease; ORR, objective response rate; DCR, disease control rate) Survival outcome Prior to PSM, the median OS time for the TACE group was 30.1 months (95% CI: 18.9–40.4) compared to 38.1 months (13.8–98.1) in the TARE group. The median PFS was recorded as 7.7 months (5.4–12.5) for the TACE group and 9.1 months (5.2–23.8) for the TARE group. Nonetheless, these disparities did not achieve statistical significance with p-values of 0.11 for OS and 0.1 for PFS. Even after PSM, the outcomes between the TACE and TARE groups remained analogous. Specifically, the TACE group exhibited a median OS time of 33.2 months (20.0-58.6) and a median PFS time of 11.5 months (7.7–18.4). The median OS, PFS for the TARE group were consistent post-PSM. Notably, there were no significant differences in OS and PFS times between the two groups following PSM, with p-values being 0.53 and 0.83, respectively, (Fig. 2 & Fig. 3 ). Of the 80 patients in the two groups post-PSM, 10 patients underwent curative treatment following their procedures. Specifically, within the TARE-treated group, 6 patients (15%) received liver resection or liver transplantation. Conversely, in the TACE group, 4 patients (10%) were administered curative treatment via the same methods. Adverse events In evaluating hospitalization duration, the median duration for the TACE group exceeded that of the TARE group in both pre- and post-PSM. Prior to PSM, the TACE group exhibited a median treatment duration of 5 days (IQR 4–7 days), whereas the TARE group’s duration was 2 days (IQR 2–3 days). Following PSM, the median durations were 5.5 days (IQR 4.8-7 days) and 2 days (IQR 2–3 days) for the TACE and TARE groups, respectively, (Table 3 ). Statistical significance was observed in the difference between the two groups pre- and post-PSM, with a p-value < 0.001. Notably, post-embolization syndrome was more prevalent in the TACE group, manifesting in 100% of patients, accounting for 171 adverse events. In comparison, the TARE group exhibited this syndrome in 30 patients (75%), with 72 adverse events (p = 0.002). When adverse events were categorized into minor (grade 1–2) and major (grade 3–4), 29 patients (72.5%) experienced major adverse events in the TACE group, whereas the TARE group reported only 2 such events (5%) with a p-value < 0.001. Clinically, abdominal pain was frequently observed in the TACE group (p < 0.001). Alterations in liver enzymes, AST and ALT, were also more prevalent in the TACE group compared to the TARE group (p < 0.001). Three patients in the TACE group developed liver failure after treatment. Conversely, in the TARE group, two patients (5%) exhibited radiographic evidence of mild radiation pneumonitis, but both patients recovered without sequelae, (Table 4 ). Table 3 Comparison of hospitalization duration between TACE and TARE treatment groups before and after PSM TACE TARE p Before PSM N 89 40 Median (IQR) (days) 5 (4–7) 2 (2–3) < 0.001 After PSM N 40 40 Median (IQR) (days) 5.5 (4.8-7) 2 (2–3) < 0.001 (PSM, propensity score matching; TARE, transarterial chemoembolization; TACE, transcatheter arterial chemoembolization; IQR, interquartile range) Table 4 Comparison of post PSM adverse events in TACE and TARE treatment groups. Adverse event TACE (n = 40) TARE (n = 40) p Any grade 3 or 4 Any grade 3 or 4 Any grade 3 or 4 Overall incidence No. of events No. patients 171 40 53 29 72 30 2 2 - 0.002 - < 0.001 Specific adverse event (no. of patients) Abdominal pain 25 2 8 1 < 0.001 - Fatigue 3 1 5 0 - - Nause 7 0 2 0 - - Vomiting 9 0 5 0 0.377 - GI ulceration 4 1 0 0 - - Cholecystitis 1 1 0 0 1 - Pleural effusion 2 1 0 0 - - Fever 7 0 3 0 0.31 - Radian pneumonitis 0 0 2 0 - - AST 36 26 12 1 < 0.001 < 0.001 ALT 38 19 12 0 < 0.001 < 0.001 Bilirubin 22 2 7 0 0.001 - Albumin 17 0 16 0 1 - (PSM, propensity score matching; AST: Aspartate aminotransferase; ALT: alanine aminotransferase) DISCUSSION Our findings demonstrate no significant difference in tumor response or survival outcomes between the TARE and TACE modalities when chosen as the initial therapeutic approach for HCC patients with tumor diameter exceeding 8 cm. The tumor response to both TACE and TARE was comparably consistent across most stages post 3, 6, and 12 months. On the other hand, the difference in survival time (OS and PFS) between the two groups was not observed both before and after PSM. Several clinical trials and studies have compared the efficacy of TARE and TACE in treating patients with early and intermediate-stage HCC. Results from the phase II TRACE randomized trial by Dhondt et al., indicated a marked advantage of TARE over DEB-TACE in treating early to intermediate-stage HCC patients with average tumor sizes ranging from 4–5 cm [ 10 ]. The median OS stood at 30.2 months post-TARE compared to 15.6 months post-DEB-TACE (p = 0.006)[ 10 ]. However, the safety profile was akin to both procedures. Research by Salem et al., on HCC patients with BCLC stages A or B revealed that TARE yielded a significantly prolonged TTP compared to cTACE (> 26 months vs 6.8 months, p = 0.012), with tumor response rates being relatively equivalent (87% vs 74%, p = 0.433)[ 27 ]. In a study by Fouly et al., involving 42 patients treated with TACE and 44 patients treated with TARE, all participants were at the intermediate stage with median tumor sizes for each group being 5.7 cm and 6.4 cm, respectively. This research demonstrated that the survival time efficacy between both treatment modalities was comparable for HCC patients [ 28 ]. However, TARE exhibited fewer hospital stays and treatment sessions compared to the TACE cohort. A meta-analysis by Brown et al., ascertained that TARE offers a notably extended time to progression (TTP) in comparison to TACE, albeit without a significant difference in terms of OS (− 0.55 months, 95% CI − 1.95 to 3.05) [ 9 ]. A study conducted by Gardini et al., corroborated these findings, affirming that both TARE and TACE yield similar outcomes in patients with unresectable HCC [ 29 ]. In the therapeutic approach to large HCC, optimizing tumor response and ensuring patient safety were invariably prioritized in a harmonious manner [ 14 ]. Diverse studies, when comparing TACE modalities (encompassing both DEB-TACE and cTACE) and DEB-TACE alone with TARE for HCC, consistently revealed a higher incidence of adverse events in the group treated with TACE [ 30 ]. However, in our research, a pronounced disparity was observed between the incidence rates of major adverse outcomes following TACE and TARE, documented at 72.5% and 5% respectively. The therapeutic strategy for large HCCs exceeding 8 cm in diameter presents inherent challenges to the medical community. Liver resection is traditionally regarded as the frontline choice, reflecting its superiority in tumor control and survival outcomes [ 1 , 31 ]. In a meta-analysis conducted by Zhou et al., which encompassed 14 studies with a cumulative patient population of 3.609, it was found that the post-PSM OS for liver resection versus TACE was 51.9% vs. 29.6% at 3 years and 37.3% vs. 21.0% at 5 years, respectively [ 2 ]. In a study by Pandey evaluating 166 HCC patients with tumors exceeding 10 cm in diameter, the median survival was documented at 20 months, with a 5-year and 10-year OS recorded at 28.6% and 25.6%, respectively[ 3 ]. However, a limited number of patients met the surgical eligibility criteria due to frequent vascular invasions, secondary hepatic lesions, and metastasis to other organs typically seen in large HCC cases [ 3 ]. These challenges necessitate the exploration of alternative safe and efficacious therapeutic modalities. Although the recent BCLC guidelines do not explicitly recommend the utilization of TARE for HCC lesions larger than 8 cm, a collective body of evidence suggests its potential as a safe and effective therapeutic option. This is further corroborated by a study from Kim et al., comparing TARE to hepatectomy for HCC lesions ≥ 5 cm. In this cohort, where patients undergoing TARE exhibited a median tumor size of 10 cm, no statistically significant difference in OS was observed between the two treatment groups, with an OS hazard ratio (HR) of 1.04 (0.42–2.59, p = 0.93)[ 13 ]. Other modalities, including transarterial ethanol ablation (TEA) and combined approaches of DEB-TACE with HAIC, have also been reported to exhibit efficacy in the management of extensive HCC [ 32 – 34 ]. Our investigation acknowledges several limitations. Primarily, due to its retrospective nature, our study encompassed a sample of merely 40 patients who underwent TARE, raising concerns regarding its representativeness for a larger cohort. It’s imperative to highlight that encountering large HCC cases remains a rarity in clinical contexts. Following this, patients were potentially ushered into divergent treatment pathways, encompassing TARE, TACE, HAIC, or systemic therapy. Such therapeutic plurality might undermine the congruence across our study groups. Nevertheless, choices pertaining to sequential treatment modalities revealed no statistically pertinent discrepancies. CONCLUSION TARE and TACE offer comparable efficacy in managing large HCC, with TARE providing a safer profile, suggesting its consideration as a preferable initial therapeutic approach for unresectable HCC patients with tumors larger than 8 cm. Abbreviations HCC: Hepatocellular carcinoma TACE: Transarterial chemoembolization TARE: Transarterial radioembolization PVTT: Portal vein tumor thrombosis BCLC: Barcelona Clinic Liver Cancer SPECT Single-photon emission computed tomography Y90: Yttrium-90 DEB-TACE: Drug eluting bead TACE cTACE: Conventional TACE HAIC: Hepatic arterial infusion chemotherapy CT: Computed tomography MRI: Magnetic resonance imaging mRECIST: Modified Response Evaluation Criteria in Solid Tumors OS: Overall survival PFS: Progression free survival PSM: Propensity score matching SD: Standard deviation IQR: Interquartile range ORR: Overall response rate Declarations Author Contribution (I) Conception and design: PNH, HJC; (II) Administrative support: PNH, HJC, JSO; (III) Provision of study materials or patients: HJC, JCO, SHK, BGC; (IV) Collection and assembly of data: PHN, HJC; (V) Data analysis and interpretation: PNH, HJC; (VI) Manuscript writing: All authors; (VII) Final approval of al manuscript: All authors. References Nguyen-Khac V, Brustia R, Rhaiem R, Regnault H, Sessa A, Mule S, et al. Liver resection for single large hepatocellular carcinoma: a prognostic factors study. Annals of Hepatology. 2022;27(6):100739. Zhou L, Zhang M, Chen S. Comparison of surgical resection and transcatheter arterial chemoembolization for large hepatocellular carcinoma: a systematic review and meta-analysis. Annals of Hepatology. 2022:100890. Pandey D, Lee K-H, Wai C-T, Wagholikar G, Tan K-C. Long term outcome and prognostic factors for large hepatocellular carcinoma (10 cm or more) after surgical resection. Annals of surgical oncology. 2007;14:2817–23. Kim GH, Kim JH, Shim JH, Ko H-K, Chu HH, Shin JH, et al. Chemoembolization for single large hepatocellular carcinoma with preserved liver function: analysis of factors predicting clinical outcomes in a 302 patient cohort. Life. 2021;11(8):840. Kwee SA, Wong LL, Sato MM, Acoba JD, Rho YS, Srivastava A, et al. Transarterial Radioembolization for Hepatocellular Carcinoma with Major Vascular Invasion: A Nationwide Propensity Score–Matched Analysis with Target Trial Emulation. Journal of Vascular and Interventional Radiology. 2021;32(9):1258–66. e6. Chung GE, Lee J-H, Kim HY, Hwang SY, Kim JS, Chung JW, et al. Transarterial chemoembolization can be safely performed in patients with hepatocellular carcinoma invading the main portal vein and may improve the overall survival. Radiology. 2011;258(2):627–34. Miyayama S, Yamashiro M, Okuda M, Yoshie Y, Sugimori N, Igarashi S, et al. Chemoembolization for the treatment of large hepatocellular carcinoma. Journal of Vascular and Interventional Radiology. 2010;21(8):1226–34. Guiu B, Garin E, Allimant C, Edeline J, Salem R. TARE in Hepatocellular Carcinoma: From the Right to the Left of BCLC. CardioVascular and Interventional Radiology. 2022;45(11):1599–607. Brown AM, Kassab I, Massani M, Townsend W, Singal AG, Soydal C, et al. TACE versus TARE for patients with hepatocellular carcinoma: Overall and individual patient level meta analysis. Cancer medicine. 2023;12(3):2590–9. Dhondt E, Lambert B, Hermie L, Huyck L, Vanlangenhove P, Geerts A, et al. 90Y radioembolization versus drug-eluting bead chemoembolization for unresectable hepatocellular carcinoma: results from the TRACE phase II randomized controlled trial. Radiology. 2022;303(3):699–710. Salem R, Johnson GE, Kim E, Riaz A, Bishay V, Boucher E, et al. Yttrium-90 radioembolization for the treatment of solitary, unresectable HCC: the LEGACY study. Hepatology. 2021;74(5):2342–52. Cardarelli-Leite L, Chung J, Klass D, Marquez V, Chou F, Ho S, et al. Ablative transarterial radioembolization improves survival in patients with HCC and portal vein tumor thrombus. CardioVascular and Interventional Radiology. 2020;43:411–22. Kim J, Kim JY, Lee J-H, Sinn DH, Hur MH, Hong JH, et al. Long-term outcomes of transarterial radioembolization for large single hepatocellular carcinoma: a comparison to resection. Journal of Nuclear Medicine. 2022;63(8):1215–22. Goswami P, Adeniran OR, K Frantz S, Matsuoka L, Du L, Gandhi RT, et al. Overall survival and toxicity of Y90 radioembolization for hepatocellular carcinoma patients in Barcelona Clinic Liver Cancer stage C (BCLC-C). BMC gastroenterology. 2022;22(1):1–10. Kim H-C, Kim GM. Radiation pneumonitis following Yttrium-90 radioembolization: A Korean multicenter study. Frontiers in Oncology. 2023;13:977160. Reig M, Forner A, Rimola J, Ferrer-Fàbrega J, Burrel M, Garcia-Criado Á, et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol. 2022;76(3):681–93. Llovet JM, De Baere T, Kulik L, Haber PK, Greten TF, Meyer T, et al. Locoregional therapies in the era of molecular and immune treatments for hepatocellular carcinoma. Nature reviews Gastroenterology & hepatology. 2021;18(5):293–313. Agirrezabal I, Bouattour M, Pinato DJ, D'Alessio A, Brennan VK, Carion PL, et al. Efficacy of transarterial radioembolization using Y-90 resin microspheres versus atezolizumab-bevacizumab in unresectable hepatocellular carcinoma: A matching-adjusted indirect comparison. European Journal of Cancer. 2024;196:113427. Makary MS, Bozer J, Miller ED, Diaz DA, Rikabi A. Long-term clinical outcomes of Yttrium-90 transarterial radioembolization for hepatocellular carcinoma: a 5-year institutional experience. Academic Radiology. 2023. Singal AG, Llovet JM, Yarchoan M, Mehta N, Heimbach JK, Dawson LA, et al. AASLD practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023:10.1097. Levillain H, Bagni O, Deroose CM, Dieudonné A, Gnesin S, Grosser OS, et al. International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres. European journal of nuclear medicine and molecular imaging. 2021;48:1570–84. Salem R, Padia SA, Lam M, Chiesa C, Haste P, Sangro B, et al. Clinical, dosimetric, and reporting considerations for Y-90 glass microspheres in hepatocellular carcinoma: updated 2022 recommendations from an international multidisciplinary working group. European Journal of Nuclear Medicine and Molecular Imaging. 2023;50(2):328–43. Liu DM, Leung TW, Chow PK, Ng DC, Lee R-C, Kim YH, et al. Clinical consensus statement: Selective internal radiation therapy with yttrium 90 resin microspheres for hepatocellular carcinoma in Asia. International Journal of Surgery. 2022;102:106094. Miller FH, Lopes Vendrami C, Gabr A, Horowitz JM, Kelahan LC, Riaz A, et al. Evolution of radioembolization in treatment of hepatocellular carcinoma: a pictorial review. RadioGraphics. 2021;41(6):1802–18. Hien PN, Chun HJ, Oh JS, Kim SH, Choi BG. Arterial-Portal Venous Shunt after Drug-Eluting Bead Transarterial Chemoembolization for Hepatocellular Carcinoma Patients: Risk factors and Impact on Patient Survival. Oncology. 2024. Cho Y, Choi JW, Kwon H, Kim KY, Lee BC, Chu HH, et al. Transarterial chemoembolization for hepatocellular carcinoma: 2023 expert consensus-based practical recommendations of the Korean Liver Cancer Association. Journal of Liver Cancer. 2023;23(2):241–61. Salem R, Gabr A, Riaz A, Mora R, Ali R, Abecassis M, et al. Institutional decision to adopt Y90 as primary treatment for hepatocellular carcinoma informed by a 1,000-patient 15‐year experience. Hepatology. 2018;68(4):1429–40. El Fouly A, Ertle J, El Dorry A, Shaker MK, Dechêne A, Abdella H, et al. In intermediate stage hepatocellular carcinoma: radioembolization with yttrium 90 or chemoembolization? Liver International. 2015;35(2):627–35. Gardini AC, Tamburini E, Iñarrairaegui M, Frassineti GL, Sangro B. Radioembolization versus chemoembolization for unresectable hepatocellular carcinoma: a meta-analysis of randomized trials. OncoTargets and therapy. 2018:7315–21. Egger ME, Armstrong E, Martin RC, Scoggins CR, Philips P, Shah M, et al. Transarterial chemoembolization vs radioembolization for neuroendocrine liver metastases: a multi-institutional analysis. Journal of the American College of Surgeons. 2020;230(4):363–70. Elhanafy E, Aboelinin M, Said R, Elmahdy Y, Aboelenin A, Fouad A, et al. Outcomes of liver resection for huge hepatocellular carcinoma exceeding 10 cm in size: A single center experience. The American Journal of Surgery. 2023;225(6):1013–21. Yu SCH, Hui JW-Y, Li L, Cho CC-M, Hui EP, Chan SL, et al. Comparison of chemoembolization, radioembolization, and transarterial ethanol ablation for huge hepatocellular carcinoma (≥ 10 cm) in tumour response and long-term survival outcome. CardioVascular and Interventional Radiology. 2022:1–10. Zhu S-L, Zhong J-H, Ke Y, Ma L, You X-M, Li L-Q. Efficacy of hepatic resection vs transarterial chemoembolization for solitary huge hepatocellular carcinoma. World Journal of Gastroenterology: WJG. 2015;21(32):9630. Huang J, Huang W, Zhan M, Guo Y, Liang L, Cai M, et al. Drug-eluting bead transarterial chemoembolization combined with FOLFOX-based hepatic arterial infusion chemotherapy for large or huge hepatocellular carcinoma. Journal of hepatocellular carcinoma. 2021:1445–58. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 25 Sep, 2024 Read the published version in Abdominal Radiology → Version 1 posted Editorial decision: Revision requested 20 Aug, 2024 Reviews received at journal 20 Aug, 2024 Reviews received at journal 20 Aug, 2024 Reviewers agreed at journal 09 Aug, 2024 Reviewers agreed at journal 08 Aug, 2024 Reviewers agreed at journal 06 Aug, 2024 Reviews received at journal 29 Jul, 2024 Reviewers agreed at journal 23 Jul, 2024 Reviewers invited by journal 20 Jun, 2024 Editor assigned by journal 19 Jun, 2024 Submission checks completed at journal 19 Jun, 2024 First submitted to journal 19 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4603096","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":319010694,"identity":"8eeba4d2-58d5-4cce-9137-fccd0fb408f8","order_by":0,"name":"Nhan Hien Phan","email":"","orcid":"","institution":"Catholic University of Korea","correspondingAuthor":false,"prefix":"","firstName":"Nhan","middleName":"Hien","lastName":"Phan","suffix":""},{"id":319010695,"identity":"2d47932b-7499-4973-8e48-e08270ad613b","order_by":1,"name":"Ho Jong Chun","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA20lEQVRIiWNgGAWjYBACAwaGBBANJJgPAGkJGVK0sIEYEjzEaGGAauEBswlrMWdvePi44JddnsHtns+vbtRY8DCwHz66AZ8Wy54DycYz+5KLDe6c3WadcwzoMJ60tBt4HXYjIU2at+dA4oYbuduMc9iAWiR4zIjVkvPMOOcfsVp4foC1MD/ObSNGyxmgX3gbkhNn3kgzY87tk+BhI+iX4z2Jj3n+2CX23Uh+/DnnW50cP/vhY3i1ACMigYGxDcxikwCT+JWDAPsBBoY/YBbzB8KqR8EoGAWjYCQCAJiCTca7TZf/AAAAAElFTkSuQmCC","orcid":"","institution":"Catholic University of Korea","correspondingAuthor":true,"prefix":"","firstName":"Ho","middleName":"Jong","lastName":"Chun","suffix":""},{"id":319010696,"identity":"5961f94e-93d6-44b5-8456-aafab22568eb","order_by":2,"name":"Jung Suk Oh","email":"","orcid":"","institution":"Catholic University of Korea","correspondingAuthor":false,"prefix":"","firstName":"Jung","middleName":"Suk","lastName":"Oh","suffix":""},{"id":319010697,"identity":"9776d67e-63fd-4f97-afd4-fa1e5e507ca2","order_by":3,"name":"Su Ho Kim","email":"","orcid":"","institution":"Catholic University of Korea","correspondingAuthor":false,"prefix":"","firstName":"Su","middleName":"Ho","lastName":"Kim","suffix":""},{"id":319010698,"identity":"9ad8dca6-c3ad-44ee-b4a7-5149b54e301a","order_by":4,"name":"Byung Gil Choi","email":"","orcid":"","institution":"Catholic University of Korea","correspondingAuthor":false,"prefix":"","firstName":"Byung","middleName":"Gil","lastName":"Choi","suffix":""}],"badges":[],"createdAt":"2024-06-19 04:25:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4603096/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4603096/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00261-024-04573-5","type":"published","date":"2024-09-25T15:57:48+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60601750,"identity":"fdcde6b5-58ce-4907-8554-c57d90927657","added_by":"auto","created_at":"2024-07-18 16:06:38","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":98326,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of the study\u003c/p\u003e","description":"","filename":"Fig.11.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4603096/v1/7e9d78342b774f632892b027.jpg"},{"id":60601748,"identity":"86ee4879-e3a1-46b3-9ac8-b8ab92e82207","added_by":"auto","created_at":"2024-07-18 16:06:38","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":235190,"visible":true,"origin":"","legend":"\u003cp\u003eThe Kaplan-Meier survival analysis of HCC patients’ overall survival (OS) and progression free survival (PFS) before PSM between TARE and TACE group. (A) The median OS time was 30.1 months (18.9-40.4) in the TACE group and 38.1 months (13.8-98.1) in the TARE group with p=0.11. (B) The median PFS time was 7.7 months (5.4-12.5) in the TACE group and 9.1 months (5.2-23.8) in the TARE group with p=0,1.\u003c/p\u003e","description":"","filename":"Fig2A1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4603096/v1/63427632e4a15848011b04f7.jpg"},{"id":60601749,"identity":"b1a122bc-d47f-4998-ade5-f1eeec00c4e9","added_by":"auto","created_at":"2024-07-18 16:06:38","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":233775,"visible":true,"origin":"","legend":"\u003cp\u003eThe Kaplan-Meier survival analysis of HCC patients’ overall survival (OS) and progression free survival (PFS) after PSM between TARE and TACE group. (A) The median OS time was 33.2 months (20.0-58.6) in the TACE group and 38.1 months (13.8-98.1) in the TARE group with p=0.534. (B) The median PFS time was 11.5 months (7.7-18.4) in the TACE group and 9.1 months (5.2-23.8) in the TARE group with p=0,83.\u003c/p\u003e","description":"","filename":"Fig3A.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4603096/v1/73948c328df17217a332386b.jpg"},{"id":65627292,"identity":"aa947cb7-2b92-4efa-befd-734461fd5748","added_by":"auto","created_at":"2024-09-30 16:14:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1299913,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4603096/v1/04ae3c57-91c7-4611-b103-4c6a9b171138.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparison of Transarterial Chemoembolization vs Radioembolization for Large Unresectable Hepatocellular Carcinoma (\u003e8cm): A Propensity Score Matching Analysis.","fulltext":[{"header":"KEY POINTS","content":"\u003cul\u003e\n \u003cli\u003ePatients with Hepatocellular Carcinoma (HCC) larger than 8cm, ineligible for surgical resection, require effective and safe alternative treatments.\u003c/li\u003e\n \u003cli\u003eTARE and TACE show similar outcomes in tumor response, overall survival (OS), and progression-free survival (PFS), with TARE leading to shorter hospital stays and fewer severe complications.\u003c/li\u003e\n \u003cli\u003eTARE offers a suitable and safe alternative for patients with large (\u0026gt;8cm) HCC.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"INTRODUCTION","content":"\u003cp\u003eHepatocellular carcinoma (HCC) is a major contributor to global cancer-related mortality. Despite significant progress in early detection and management of risk factors, a substantial portion of cases are diagnosed with large HCC (\u0026gt;\u0026thinsp;8cm), posing dilemmas in treatment strategies. Surgical resection, advocated in various guidelines for large HCC, has been shown to provide superior survival benefits compared to other treatments [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. However, the risk of postoperative liver failure, as well as common occurrences in patients with large HCC, such as vascular invasion, intrahepatic spread, and compromised liver function, significantly limit the number of patients eligible for surgery [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Consequently, alternative treatment modalities must be considered.\u003c/p\u003e \u003cp\u003eTransarterial chemoembolization (TACE) and transarterial radioembolization (TARE) are considered leading alternative treatments for patients with unresectable HCC. However, the efficacy of TACE is often limited when treating large tumors due to the presence of extensive extrahepatic collateral circulation and a low rate of complete response [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Although superselective or selective techniques have optimized the use of embolic materials, the extensive use of Lipiodol can compromise liver function and exacerbate postembolization syndrome, increasing the risk of complications such as pulmonary embolism [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Miyayama et al. recommend the use of stepwise TACE sessions to achieve optimal tumor response while minimizing adverse effects [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTARE is widely used across various stages of HCC [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Notably, large vessel occlusion is rare post-TARE, resulting in fewer complications such as post-embolization syndrome compared to TACE [\u003cspan additionalcitationids=\"CR9 CR10\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. According to Meerun et al., TARE has shown significant response rates in HCC cases with portal vein tumor thrombosis (PVTT) and multifocal disease [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In a specific study where a significant majority of patients had tumors larger than 8 cm, Kim et al. reported that the therapeutic efficacy of TARE was comparable to liver resection [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. However, large HCCs often exhibit a high lung shunt fraction and numerous extrahepatic branches, elevating the risk of radiation pneumonitis or adjacent organ damage post-TARE [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Consequently, the Barcelona Clinic Liver Cancer (BCLC) staging system recommends TARE primarily for HCC patients with single lesions smaller than 8 cm [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe era of immunotherapy, highlighted by the positive outcomes from the combination of Atezolizumab and Bevacizumab, has transformed the treatment landscape for hepatocellular carcinoma, particularly in advanced-stage HCC [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However, the effectiveness of these therapies in patients with large HCC tumors and high tumor burdens remains unproven [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Thus, local therapy such as TARE and TACE retain a crucial role in contemporary clinical settings [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This study aims to assess the safety and efficacy of TACE versus TARE in the management of patients with large HCC exceeding 8 cm.\u003c/p\u003e"},{"header":"MATERIALS \u0026 METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePatient selection\u003c/h2\u003e \u003cp\u003e A retrospective study was approved by our hospital\u0026rsquo;s Institutional Review Board and patient consent was waived due to the study design. The study included all HCC patients with a tumor size larger than 8 cm who were treated with either TACE or TARE from January 2010 to December 2020 meeting the following criteria: (1) TACE or TARE as the initial treatment choice; (2) maximum diameter of the tumor exceeding 8 cm; (3) age\u0026thinsp;\u0026ge;\u0026thinsp;18 years; (4) Eastern Cooperative Oncology Group performance status 1 or 2; (5) Child-Pugh score of A or B (7 points). Exclusion criteria were as follows: (1) patients who received prior treatments such as liver resection, RFA, systemic therapy, or hepatic arterial infusion chemotherapy (HAIC); (2) age\u0026thinsp;\u0026lt;\u0026thinsp;18 years; (3) having another malignant disease or a history of malignancy within 5 years from the start of treatment. All patients were diagnosed with HCC based on the American Association for the Study of Liver Diseases criteria [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eProcedure\u003c/h2\u003e \u003cp\u003eThe procedure was performed by three interventional radiologists with over ten years of experience in treating HCC using TARE and TACE. The choice of treatment method was based on discussions between the physician and the patient, considering the availability and cost of the technique.\u003c/p\u003e \u003cp\u003e \u003cem\u003eTARE procedure.\u003c/em\u003e \u003c/p\u003e \u003cp\u003ePrior to commencing the TARE procedure, planning and dosimetry calculation were undertaken following the injection of Technetium-99m macroaggregated albumin into the hepatic artery. After this, single-photon emission computed tomography (SPECT/CT) imaging was employed to evaluate specific parameters. Quantitative metrics such as the hepatopulmonary shunt fraction (HSF) and the uptake ratio between the tumor and liver parenchyma were determined. This protocol incorporated a comprehensive assessment of the tumor-feeding arteries, in addition to the extrahepatic collaterals. Extrahepatic collateral arteries were embolized with coils or microspheres before performing TARE. TARE utilizes Yttrium-90 (Y90), which can be loaded onto either glass microspheres (TheraSphere\u0026reg;) or resin microspheres (SIR-Spheres\u0026reg;). The selection of the target lobe, segment, or subsegment is based on preprocedural imaging and tumor distribution. The dosage of Y90 is determined based on preprocedural CT hepatic arteriography (CTHA) and CT portography (CTPA) imaging, following the manufacturer\u0026rsquo;s guidelines [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This ensures that the pulmonary dose does not exceed 20 Gy and the liver parenchyma dose remains under 70 Gy (40 Gy for single-dose Y90 to compromised liver), while simultaneously optimizing the tumor dose to achieve the most favorable tumor response [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Patients with an HSF greater than 20% were not considered candidates for TARE. Patients with an HSF between 10% and 20% had their doses adjusted to ensure the pulmonary dose remained within safe limits. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Post-therapy dose distribution is evaluated using bremsstrahlung imaging with SPECT/CT immediately following the procedure [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eTACE procedure\u003c/h2\u003e \u003cp\u003eThe procedures were conducted under the guidance of Emboguide software (Syngo Embolization Guidance, Siemens, Frankenthal, Germany) using cone-beam CT imaging. Microcatheters, ranging from 1.6 Fr to 1.8 Fr (Progreat; Terumo, Tokyo, Japan, and Asahi; Asahi Intecc, Nagoya, Japan), were utilized to access tumor-feeding vessels employing either superselective or selective techniques. Both conventional transarterial chemoembolization (cTACE) and drug-eluting bead TACE (DEB-TACE) modalities were chosen based on availability. For cTACE, a dose of 50 mg of doxorubicin (Ildong, Seoul, Korea) was dissolved in contrast media (Visipaque 270; GE Healthcare, Waukesha, USA) and 15 ml of Lipiodol (Guerbet, Roissy, France). Tumor-feeding arteries were embolized using gelatin microparticles sized 150\u0026ndash;350 \u0026micro;m (EG Gel, Engain, Gyeonggi, Korea). For DEB-TACE, drug-eluting beads (DC-Bead, Boston Scientific, Marlborough, MA, USA) sized 100\u0026ndash;300 \u0026micro;m were used. A vial of DC-Bead was loaded with 50 mg of doxorubicin over 30\u0026ndash;60 minutes. The loaded DC-Beads were then diluted with 20 ml of contrast agent (Visipaque 270) and 20 ml of normal saline, creating a 40 ml mixture. For DEB-TACE, the endpoint for occlusion of the feeding arteries was typically near stasis of the contrast media [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eSubsequent treatment considerations\u003c/h2\u003e \u003cp\u003eThe initial tumor response after TARE is typically assessed three months post-procedure, whereas for TACE, it is assessed after one month. It is crucial to promptly determine subsequent treatment options upon confirming the presence of residual tumor to achieve optimal tumor control. Depending on the tumor response, the extent of residual tumor mass, and hepatic function, the next chosen treatment modality may include TACE, systemic therapy, or hepatic arterial infusion chemotherapy (HAIC).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eAssessments\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eTumor response and survival outcomes\u003c/h2\u003e \u003cp\u003eTumor response was assessed using the modified Response Evaluation Criteria in Solid Tumors (mRECIST) based on imaging either via contrast-enhanced CT or magnetic resonance imaging (MRI) at the 3, 6, and 12-month intervals. In this context, the overall response rate (ORR) was defined as the sum of both complete response (CR) and partial response (PR). The disease control rate (DCR) encompassed CR, PR, and stable disease (SD). The best tumor response referred to the most favorable tumor response recorded during treatment. Overall survival (OS) was calculated from the time the patient began receiving TACE or TARE treatment until the time of death. Progression-free survival (PFS) was calculated from the time the patient began receiving TACE or TARE treatment until disease progression or death, whichever occurred first.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eAdverse events\u003c/h2\u003e \u003cp\u003eAdverse events were recorded clinically and through laboratory tests based on common terminology criteria for adverse events, version 5.0. All adverse events that occurred during the post-procedure hospitalization period or that necessitated unplanned hospital admissions were documented. Laboratory abnormalities were recorded within one month following the procedure. We categorized these adverse events into minor (grades 1 and 2) and major with higher grades. The duration of hospital stay was calculated from the time the patient underwent TARE or TACE until discharge during this initial treatment course.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003ePropensity score matching (PSM)\u003c/h2\u003e \u003cp\u003eTo ensure comparability between the two treatment groups, TACE, and TARE, we employed PSM at a 1:1 ratio. The variables incorporated into the propensity model consisted of gender, age, Child-Pugh score, BCLC stage, maximum tumor size, tumor number, tumor location, tumor type, and PVTT with a caliper of 0.2. After this matching process, a comparative analysis between TACE and TARE was conducted using both pre-PSM and post-PSM datasets.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were used to summarize the data, with categorical variables presented as frequencies and proportions. Continuous variables adhering to a normal distribution were described using mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (SD), while those not following normality were represented by median and interquartile range (IQR). The Chi-square test compared two categorical variables, with Fisher\u0026rsquo;s exact test employed as an alternative when more than 20% of expected values were below 5. Continuous variables were assessed using the independent T-test or Mann-Whitney U test, depending on their distribution. Survival outcomes were delineated using Kaplan-Meier curves and compared via the Log-rank test. Statistical significance was defined as a p-value less than 0.05. Analyses were conducted using IBM SPSS Statistics version 26 (IBM Corp, Armonk, NY, USA) and R 4.3.1.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics\u003c/h2\u003e \u003cp\u003eWe enrolled 129 HCC patients with lesions exceeding 8 cm in diameter, meeting our study criteria. Among them, 40 patients underwent TARE while 89 received TACE. Both groups showed comparability in fundamental characteristics, including age, gender, Child-Pugh score, BCLC stage, tumor size, tumor type, PVTT presence, tumor markers, and baseline liver function tests. Notably, a significant disparity emerged regarding tumor location, with the TARE group exhibiting a higher frequency of single-lobe tumors compared to the TACE group (82.5% vs. 67%). This variance arose due to the deliberate avoidance of bilobar approaches in TARE, driven by concerns over potential liver function decline. Correspondingly, tumor numbers also differed significantly: 72.5% of TARE patients presented with a single tumor, whereas 47.2% of TACE patients had the same (p\u0026thinsp;=\u0026thinsp;0.026). Additionally, median serum AST concentration was lower in the TARE group compared to the TACE group (53\u0026thinsp;\u0026plusmn;\u0026thinsp;41 U/L vs 65\u0026thinsp;\u0026plusmn;\u0026thinsp;22 U/L) respectively; p\u0026thinsp;=\u0026thinsp;0.043). Propensity score matching (PSM) was employed to ensure balanced study cohorts, resulting in no statistically significant differences in primary characteristics between the two groups post-PSM. Among the TACE group after PSM, 4 patients (10%) underwent DEB-TACE, while 36 patients (90%) received cTACE (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe baseline characteristics of all patients before and after PSM.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBefore PSM\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eAfter PSM\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTARE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTARE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89 (69.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (31.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e40 (50.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (78.7)\u003c/p\u003e \u003cp\u003e19 (21.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (80.0)\u003c/p\u003e \u003cp\u003e8 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31(77.5)\u003c/p\u003e \u003cp\u003e9 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32 (80.0)\u003c/p\u003e \u003cp\u003e8 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.785\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003cp\u003e\u0026le; 60\u003c/p\u003e \u003cp\u003e\u0026gt; 60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (44.9)\u003c/p\u003e \u003cp\u003e49 (55.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (45.0)\u003c/p\u003e \u003cp\u003e22 (55.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.995\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19 (45.7)\u003c/p\u003e \u003cp\u003e21 (52.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e18 (54.0)\u003c/p\u003e \u003cp\u003e22 (55.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.823\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEtiology\u003c/p\u003e \u003cp\u003eHBV\u003c/p\u003e \u003cp\u003eHCV\u003c/p\u003e \u003cp\u003eAlcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (50.8)\u003c/p\u003e \u003cp\u003e3 (4.9)\u003c/p\u003e \u003cp\u003e27 (44.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (64.5)\u003c/p\u003e \u003cp\u003e3 (9.7)\u003c/p\u003e \u003cp\u003e8 (25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 (67.7)\u003c/p\u003e \u003cp\u003e2 (6.5)\u003c/p\u003e \u003cp\u003e8 (25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20 (64.5)\u003c/p\u003e \u003cp\u003e3 (9.7)\u003c/p\u003e \u003cp\u003e8 (25.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChild-Pugh score\u003c/p\u003e \u003cp\u003eA\u003c/p\u003e \u003cp\u003eB\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (91.0)\u003c/p\u003e \u003cp\u003e8 (9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (97.5)\u003c/p\u003e \u003cp\u003e1 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e38 (95.0)\u003c/p\u003e \u003cp\u003e2 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e39 (97.5)\u003c/p\u003e \u003cp\u003e1 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCLC\u003c/p\u003e \u003cp\u003eA\u003c/p\u003e \u003cp\u003eB\u003c/p\u003e \u003cp\u003eC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (37.1)\u003c/p\u003e \u003cp\u003e30 (33.7)\u003c/p\u003e \u003cp\u003e26 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (47.5)\u003c/p\u003e \u003cp\u003e8 (20.0)\u003c/p\u003e \u003cp\u003e13 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23 (57.5)\u003c/p\u003e \u003cp\u003e5 (12.5)\u003c/p\u003e \u003cp\u003e12 (30.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e19 (47.5)\u003c/p\u003e \u003cp\u003e8 (20.0)\u003c/p\u003e \u003cp\u003e13 (32.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.573\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMaximum tumor size (cm)\u003c/p\u003e \u003cp\u003e8\u0026ndash;10 cm\u003c/p\u003e \u003cp\u003e\u0026gt; 10 cm\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 (39.3)\u003c/p\u003e \u003cp\u003e54 (60.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (37.5)\u003c/p\u003e \u003cp\u003e25 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.844\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (37.5)\u003c/p\u003e \u003cp\u003e25 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e15 (37.5)\u003c/p\u003e \u003cp\u003e25 (62.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor number\u003c/p\u003e \u003cp\u003e1\u003c/p\u003e \u003cp\u003e2\u0026ndash;5\u003c/p\u003e \u003cp\u003e\u0026gt;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42 (47.2)\u003c/p\u003e \u003cp\u003e33 (37.1)\u003c/p\u003e \u003cp\u003e14 (15.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (72.5)\u003c/p\u003e \u003cp\u003e7 (17.5)\u003c/p\u003e \u003cp\u003e4 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (72.5)\u003c/p\u003e \u003cp\u003e9 (22.5)\u003c/p\u003e \u003cp\u003e2 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29 (72.5)\u003c/p\u003e \u003cp\u003e7 (17.5)\u003c/p\u003e \u003cp\u003e4 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.632\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor Location\u003c/p\u003e \u003cp\u003eUnilobar\u003c/p\u003e \u003cp\u003eBilobar\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60 (67.4)\u003c/p\u003e \u003cp\u003e29 (32.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (82.5)\u003c/p\u003e \u003cp\u003e6 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33 (82.5)\u003c/p\u003e \u003cp\u003e7 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e33 (82.5)\u003c/p\u003e \u003cp\u003e6 (17.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTumor types\u003c/p\u003e \u003cp\u003eFocal massive\u003c/p\u003e \u003cp\u003eInfiltrative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e63 (70.8)\u003c/p\u003e \u003cp\u003e26 (29.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (80.0)\u003c/p\u003e \u003cp\u003e8 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31 (77.5)\u003c/p\u003e \u003cp\u003e9 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e32 (80.0)\u003c/p\u003e \u003cp\u003e8 (20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.785\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePVTT\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (25.8)\u003c/p\u003e \u003cp\u003e66 (74.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (40.0)\u003c/p\u003e \u003cp\u003e24 (60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12 (30.0)\u003c/p\u003e \u003cp\u003e28 (70.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e16 (40.0)\u003c/p\u003e \u003cp\u003e24 (60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.348\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAFP\u003c/p\u003e \u003cp\u003e\u0026le; 400\u003c/p\u003e \u003cp\u003e\u0026gt; 400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (46.1)\u003c/p\u003e \u003cp\u003e48 (53.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (55.0)\u003c/p\u003e \u003cp\u003e18 (45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e18 (45.0)\u003c/p\u003e \u003cp\u003e22 (55.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e22 (55.0)\u003c/p\u003e \u003cp\u003e18 (45.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.371\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilirubin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.42.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.125\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.67\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.58\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.488\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.61\u0026thinsp;\u0026plusmn;\u0026thinsp;0.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.734\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e65\u0026thinsp;\u0026plusmn;\u0026thinsp;22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u0026thinsp;\u0026plusmn;\u0026thinsp;41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56\u0026thinsp;\u0026plusmn;\u0026thinsp;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e53\u0026thinsp;\u0026plusmn;\u0026thinsp;38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.690\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u0026thinsp;\u0026plusmn;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37\u0026thinsp;\u0026plusmn;\u0026thinsp;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34\u0026thinsp;\u0026plusmn;\u0026thinsp;21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e37\u0026thinsp;\u0026plusmn;\u0026thinsp;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.433\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurative Treatment.\u003c/p\u003e \u003cp\u003eLiver resection\u003c/p\u003e \u003cp\u003eLiver transplantation\u003c/p\u003e \u003cp\u003eSubsequent treatment\u003c/p\u003e \u003cp\u003eTACE\u003c/p\u003e \u003cp\u003eHAIC\u003c/p\u003e \u003cp\u003eSystemic therapy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(6.7)\u003c/p\u003e \u003cp\u003e3(3.4)\u003c/p\u003e \u003cp\u003e72(80.9)\u003c/p\u003e \u003cp\u003e10(11.2)\u003c/p\u003e \u003cp\u003e7(7.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4(10)\u003c/p\u003e \u003cp\u003e2(4)\u003c/p\u003e \u003cp\u003e30(75)\u003c/p\u003e \u003cp\u003e5(12.5)\u003c/p\u003e \u003cp\u003e5(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.625\u003c/p\u003e \u003cp\u003e0.671\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2(5)\u003c/p\u003e \u003cp\u003e2(5)\u003c/p\u003e \u003cp\u003e35(87.5)\u003c/p\u003e \u003cp\u003e2(5)\u003c/p\u003e \u003cp\u003e3(7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4(10)\u003c/p\u003e \u003cp\u003e2(4)\u003c/p\u003e \u003cp\u003e30(75)\u003c/p\u003e \u003cp\u003e5(12.5)\u003c/p\u003e \u003cp\u003e5(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.744\u003c/p\u003e \u003cp\u003e0.338\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003eHCC, hepatocellular carcinoma; PSM, propensity score matching; TARE, transarterial chemoembolization; TACE, transcatheter arterial chemoembolization; AFP, alpha-fetoprotein; PVTT: portal vein tumor thrombosis; PLT: platelet; AST: Aspartate aminotransferase; ALT: alanine aminotransferase; BCLC: Barcelona Clinic Liver Cancer; HAIC, hepatic artery infusion chemotherapy.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eTumor response\u003c/h2\u003e \u003cp\u003eThe tumor response at the 3-month, 6-month, and 12-month time points, as well as the best observed tumor response, are documented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The tumor response to both treatment modalities demonstrated minimal variation across most time intervals. However, at the 6-month juncture, TACE exhibited superior tumor control rates in terms of DCR (p\u0026thinsp;=\u0026thinsp;0.003). The best tumor response between the two groups was comparable; patients treated with TACE had an ORR of 72.6%, while those treated with TARE had an ORR of 72.5%. Concurrently, the DCR for the two groups was 83.1% and 87.5%, respectively, (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of post-PSM tumor response between groups treated with TACE and TARE.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTumor response\u003c/p\u003e \u003cp\u003e(After PSM)\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e3 months\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003e6 months\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;68)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c10\" namest=\"c8\"\u003e \u003cp\u003e12 months\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;54)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e \u003cp\u003eBest tumor response\u003c/p\u003e \u003cp\u003e(N\u0026thinsp;=\u0026thinsp;78)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;38)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTARE\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;40)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;31)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTARE\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;37)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;26)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eTARE\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;28)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;38)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eTARE\u003c/p\u003e \u003cp\u003e\u003cem\u003e(n\u0026thinsp;=\u0026thinsp;40)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8(21.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13(41.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e10(27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.626\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e12(46.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e9(32.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.438\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e14(36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e12(30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.506\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17(44.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23(57.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9(29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e14(40.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7(26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e8(28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e14(36.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e17(42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(18.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.668\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5(16.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3(8.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e1(3.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e4(10)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e6(15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6(15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.927\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4(12.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9(24.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7(26.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e10(35.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e6(15.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e5(12.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.810\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eORR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65.8%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.947\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70.9%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e73.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e60.7%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e72.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e72.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.625\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDCR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84.2%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.927\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75.6%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e73.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e \u003cp\u003e64.3%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e83.1%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e87.5%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.981\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003ePSM, propensity score matching; TARE, transarterial chemoembolization; TACE, transcatheter arterial chemoembolization; CR, complete response; PR, partial response; SD, stable disease; ORR, objective response rate; DCR, disease control rate)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSurvival outcome\u003c/h2\u003e \u003cp\u003ePrior to PSM, the median OS time for the TACE group was 30.1 months (95% CI: 18.9\u0026ndash;40.4) compared to 38.1 months (13.8\u0026ndash;98.1) in the TARE group. The median PFS was recorded as 7.7 months (5.4\u0026ndash;12.5) for the TACE group and 9.1 months (5.2\u0026ndash;23.8) for the TARE group. Nonetheless, these disparities did not achieve statistical significance with p-values of 0.11 for OS and 0.1 for PFS. Even after PSM, the outcomes between the TACE and TARE groups remained analogous. Specifically, the TACE group exhibited a median OS time of 33.2 months (20.0-58.6) and a median PFS time of 11.5 months (7.7\u0026ndash;18.4). The median OS, PFS for the TARE group were consistent post-PSM. Notably, there were no significant differences in OS and PFS times between the two groups following PSM, with p-values being 0.53 and 0.83, respectively, (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u0026amp; Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Of the 80 patients in the two groups post-PSM, 10 patients underwent curative treatment following their procedures. Specifically, within the TARE-treated group, 6 patients (15%) received liver resection or liver transplantation. Conversely, in the TACE group, 4 patients (10%) were administered curative treatment via the same methods.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eAdverse events\u003c/h2\u003e \u003cp\u003eIn evaluating hospitalization duration, the median duration for the TACE group exceeded that of the TARE group in both pre- and post-PSM. Prior to PSM, the TACE group exhibited a median treatment duration of 5 days (IQR 4\u0026ndash;7 days), whereas the TARE group\u0026rsquo;s duration was 2 days (IQR 2\u0026ndash;3 days). Following PSM, the median durations were 5.5 days (IQR 4.8-7 days) and 2 days (IQR 2\u0026ndash;3 days) for the TACE and TARE groups, respectively, (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Statistical significance was observed in the difference between the two groups pre- and post-PSM, with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001. Notably, post-embolization syndrome was more prevalent in the TACE group, manifesting in 100% of patients, accounting for 171 adverse events. In comparison, the TARE group exhibited this syndrome in 30 patients (75%), with 72 adverse events (p\u0026thinsp;=\u0026thinsp;0.002). When adverse events were categorized into minor (grade 1\u0026ndash;2) and major (grade 3\u0026ndash;4), 29 patients (72.5%) experienced major adverse events in the TACE group, whereas the TARE group reported only 2 such events (5%) with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001. Clinically, abdominal pain was frequently observed in the TACE group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Alterations in liver enzymes, AST and ALT, were also more prevalent in the TACE group compared to the TARE group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Three patients in the TACE group developed liver failure after treatment. Conversely, in the TARE group, two patients (5%) exhibited radiographic evidence of mild radiation pneumonitis, but both patients recovered without sequelae, (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of hospitalization duration between TACE and TARE treatment groups before and after PSM\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eTARE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eBefore PSM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (IQR) (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (4\u0026ndash;7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAfter PSM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMedian (IQR) (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.5 (4.8-7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (2\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e(PSM, propensity score matching; TARE, transarterial chemoembolization; TACE, transcatheter arterial chemoembolization; IQR, interquartile range)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of post PSM adverse events in TACE and TARE treatment groups.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAdverse event\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eTACE\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eTARE\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;40)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAny grade\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 or 4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAny grade\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3 or 4\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eAny grade\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e3 or 4\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOverall incidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo. of events\u003c/p\u003e \u003cp\u003eNo. patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e171\u003c/p\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53\u003c/p\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e72\u003c/p\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"12\" rowspan=\"13\"\u003e \u003cp\u003eSpecific adverse event\u003c/p\u003e \u003cp\u003e(no. of patients)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAbdominal pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNause\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVomiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.377\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGI ulceration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCholecystitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePleural effusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRadian pneumonitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAST\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eALT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBilirubin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlbumin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"8\"\u003e(PSM, propensity score matching; AST: Aspartate aminotransferase; ALT: alanine aminotransferase)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur findings demonstrate no significant difference in tumor response or survival outcomes between the TARE and TACE modalities when chosen as the initial therapeutic approach for HCC patients with tumor diameter exceeding 8 cm. The tumor response to both TACE and TARE was comparably consistent across most stages post 3, 6, and 12 months. On the other hand, the difference in survival time (OS and PFS) between the two groups was not observed both before and after PSM.\u003c/p\u003e \u003cp\u003eSeveral clinical trials and studies have compared the efficacy of TARE and TACE in treating patients with early and intermediate-stage HCC. Results from the phase II TRACE randomized trial by Dhondt et al., indicated a marked advantage of TARE over DEB-TACE in treating early to intermediate-stage HCC patients with average tumor sizes ranging from 4\u0026ndash;5 cm [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The median OS stood at 30.2 months post-TARE compared to 15.6 months post-DEB-TACE (p\u0026thinsp;=\u0026thinsp;0.006)[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. However, the safety profile was akin to both procedures. Research by Salem et al., on HCC patients with BCLC stages A or B revealed that TARE yielded a significantly prolonged TTP compared to cTACE (\u0026gt;\u0026thinsp;26 months vs 6.8 months, p\u0026thinsp;=\u0026thinsp;0.012), with tumor response rates being relatively equivalent (87% vs 74%, p\u0026thinsp;=\u0026thinsp;0.433)[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In a study by Fouly et al., involving 42 patients treated with TACE and 44 patients treated with TARE, all participants were at the intermediate stage with median tumor sizes for each group being 5.7 cm and 6.4 cm, respectively. This research demonstrated that the survival time efficacy between both treatment modalities was comparable for HCC patients [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. However, TARE exhibited fewer hospital stays and treatment sessions compared to the TACE cohort. A meta-analysis by Brown et al., ascertained that TARE offers a notably extended time to progression (TTP) in comparison to TACE, albeit without a significant difference in terms of OS (\u0026minus;\u0026thinsp;0.55 months, 95% CI \u0026minus;\u0026thinsp;1.95 to 3.05) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A study conducted by Gardini et al., corroborated these findings, affirming that both TARE and TACE yield similar outcomes in patients with unresectable HCC [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the therapeutic approach to large HCC, optimizing tumor response and ensuring patient safety were invariably prioritized in a harmonious manner [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Diverse studies, when comparing TACE modalities (encompassing both DEB-TACE and cTACE) and DEB-TACE alone with TARE for HCC, consistently revealed a higher incidence of adverse events in the group treated with TACE [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. However, in our research, a pronounced disparity was observed between the incidence rates of major adverse outcomes following TACE and TARE, documented at 72.5% and 5% respectively.\u003c/p\u003e \u003cp\u003eThe therapeutic strategy for large HCCs exceeding 8 cm in diameter presents inherent challenges to the medical community. Liver resection is traditionally regarded as the frontline choice, reflecting its superiority in tumor control and survival outcomes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. In a meta-analysis conducted by Zhou et al., which encompassed 14 studies with a cumulative patient population of 3.609, it was found that the post-PSM OS for liver resection versus TACE was 51.9% vs. 29.6% at 3 years and 37.3% vs. 21.0% at 5 years, respectively [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In a study by Pandey evaluating 166 HCC patients with tumors exceeding 10 cm in diameter, the median survival was documented at 20 months, with a 5-year and 10-year OS recorded at 28.6% and 25.6%, respectively[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, a limited number of patients met the surgical eligibility criteria due to frequent vascular invasions, secondary hepatic lesions, and metastasis to other organs typically seen in large HCC cases [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These challenges necessitate the exploration of alternative safe and efficacious therapeutic modalities. Although the recent BCLC guidelines do not explicitly recommend the utilization of TARE for HCC lesions larger than 8 cm, a collective body of evidence suggests its potential as a safe and effective therapeutic option. This is further corroborated by a study from Kim et al., comparing TARE to hepatectomy for HCC lesions\u0026thinsp;\u0026ge;\u0026thinsp;5 cm. In this cohort, where patients undergoing TARE exhibited a median tumor size of 10 cm, no statistically significant difference in OS was observed between the two treatment groups, with an OS hazard ratio (HR) of 1.04 (0.42\u0026ndash;2.59, p\u0026thinsp;=\u0026thinsp;0.93)[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Other modalities, including transarterial ethanol ablation (TEA) and combined approaches of DEB-TACE with HAIC, have also been reported to exhibit efficacy in the management of extensive HCC [\u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur investigation acknowledges several limitations. Primarily, due to its retrospective nature, our study encompassed a sample of merely 40 patients who underwent TARE, raising concerns regarding its representativeness for a larger cohort. It\u0026rsquo;s imperative to highlight that encountering large HCC cases remains a rarity in clinical contexts. Following this, patients were potentially ushered into divergent treatment pathways, encompassing TARE, TACE, HAIC, or systemic therapy. Such therapeutic plurality might undermine the congruence across our study groups. Nevertheless, choices pertaining to sequential treatment modalities revealed no statistically pertinent discrepancies.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eTARE and TACE offer comparable efficacy in managing large HCC, with TARE providing a safer profile, suggesting its consideration as a preferable initial therapeutic approach for unresectable HCC patients with tumors larger than 8 cm.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHCC: \u0026nbsp;Hepatocellular carcinoma\u003c/p\u003e\n\u003cp\u003eTACE: Transarterial chemoembolization\u003c/p\u003e\n\u003cp\u003eTARE: Transarterial radioembolization\u003c/p\u003e\n\u003cp\u003ePVTT: \u0026nbsp;Portal vein tumor thrombosis\u003c/p\u003e\n\u003cp\u003eBCLC: Barcelona Clinic Liver Cancer\u003c/p\u003e\n\u003cp\u003eSPECT Single-photon emission computed tomography\u003c/p\u003e\n\u003cp\u003eY90: Yttrium-90\u003c/p\u003e\n\u003cp\u003eDEB-TACE: Drug eluting bead TACE\u003c/p\u003e\n\u003cp\u003ecTACE: Conventional TACE\u003c/p\u003e\n\u003cp\u003eHAIC: Hepatic arterial infusion chemotherapy\u003c/p\u003e\n\u003cp\u003eCT: Computed tomography\u003c/p\u003e\n\u003cp\u003eMRI: Magnetic resonance imaging\u003c/p\u003e\n\u003cp\u003emRECIST: Modified Response Evaluation Criteria in Solid Tumors\u003c/p\u003e\n\u003cp\u003eOS: Overall survival\u003c/p\u003e\n\u003cp\u003ePFS: Progression free survival\u003c/p\u003e\n\u003cp\u003ePSM: Propensity score matching\u003c/p\u003e\n\u003cp\u003eSD: Standard deviation\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIQR: Interquartile range\u003c/p\u003e\n\u003cp\u003eORR: Overall response rate\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003e(I) Conception and design: PNH, HJC; (II) Administrative support: PNH, HJC, JSO; (III) Provision of study materials or patients: HJC, JCO, SHK, BGC; (IV) Collection and assembly of data: PHN, HJC; (V) Data analysis and interpretation: PNH, HJC; (VI) Manuscript writing: All authors; (VII) Final approval of al manuscript: All authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eNguyen-Khac V, Brustia R, Rhaiem R, Regnault H, Sessa A, Mule S, et al. Liver resection for single large hepatocellular carcinoma: a prognostic factors study. Annals of Hepatology. 2022;27(6):100739.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou L, Zhang M, Chen S. Comparison of surgical resection and transcatheter arterial chemoembolization for large hepatocellular carcinoma: a systematic review and meta-analysis. Annals of Hepatology. 2022:100890.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePandey D, Lee K-H, Wai C-T, Wagholikar G, Tan K-C. Long term outcome and prognostic factors for large hepatocellular carcinoma (10 cm or more) after surgical resection. Annals of surgical oncology. 2007;14:2817\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim GH, Kim JH, Shim JH, Ko H-K, Chu HH, Shin JH, et al. Chemoembolization for single large hepatocellular carcinoma with preserved liver function: analysis of factors predicting clinical outcomes in a 302 patient cohort. Life. 2021;11(8):840.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKwee SA, Wong LL, Sato MM, Acoba JD, Rho YS, Srivastava A, et al. Transarterial Radioembolization for Hepatocellular Carcinoma with Major Vascular Invasion: A Nationwide Propensity Score\u0026ndash;Matched Analysis with Target Trial Emulation. Journal of Vascular and Interventional Radiology. 2021;32(9):1258\u0026ndash;66. e6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChung GE, Lee J-H, Kim HY, Hwang SY, Kim JS, Chung JW, et al. Transarterial chemoembolization can be safely performed in patients with hepatocellular carcinoma invading the main portal vein and may improve the overall survival. Radiology. 2011;258(2):627\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiyayama S, Yamashiro M, Okuda M, Yoshie Y, Sugimori N, Igarashi S, et al. Chemoembolization for the treatment of large hepatocellular carcinoma. Journal of Vascular and Interventional Radiology. 2010;21(8):1226\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuiu B, Garin E, Allimant C, Edeline J, Salem R. TARE in Hepatocellular Carcinoma: From the Right to the Left of BCLC. CardioVascular and Interventional Radiology. 2022;45(11):1599\u0026ndash;607.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBrown AM, Kassab I, Massani M, Townsend W, Singal AG, Soydal C, et al. TACE versus TARE for patients with hepatocellular carcinoma: Overall and individual patient level meta analysis. Cancer medicine. 2023;12(3):2590\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDhondt E, Lambert B, Hermie L, Huyck L, Vanlangenhove P, Geerts A, et al. 90Y radioembolization versus drug-eluting bead chemoembolization for unresectable hepatocellular carcinoma: results from the TRACE phase II randomized controlled trial. Radiology. 2022;303(3):699\u0026ndash;710.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalem R, Johnson GE, Kim E, Riaz A, Bishay V, Boucher E, et al. Yttrium-90 radioembolization for the treatment of solitary, unresectable HCC: the LEGACY study. Hepatology. 2021;74(5):2342\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCardarelli-Leite L, Chung J, Klass D, Marquez V, Chou F, Ho S, et al. Ablative transarterial radioembolization improves survival in patients with HCC and portal vein tumor thrombus. CardioVascular and Interventional Radiology. 2020;43:411\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim J, Kim JY, Lee J-H, Sinn DH, Hur MH, Hong JH, et al. Long-term outcomes of transarterial radioembolization for large single hepatocellular carcinoma: a comparison to resection. Journal of Nuclear Medicine. 2022;63(8):1215\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoswami P, Adeniran OR, K Frantz S, Matsuoka L, Du L, Gandhi RT, et al. Overall survival and toxicity of Y90 radioembolization for hepatocellular carcinoma patients in Barcelona Clinic Liver Cancer stage C (BCLC-C). BMC gastroenterology. 2022;22(1):1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim H-C, Kim GM. Radiation pneumonitis following Yttrium-90 radioembolization: A Korean multicenter study. Frontiers in Oncology. 2023;13:977160.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReig M, Forner A, Rimola J, Ferrer-F\u0026agrave;brega J, Burrel M, Garcia-Criado \u0026Aacute;, et al. BCLC strategy for prognosis prediction and treatment recommendation: The 2022 update. J Hepatol. 2022;76(3):681\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLlovet JM, De Baere T, Kulik L, Haber PK, Greten TF, Meyer T, et al. Locoregional therapies in the era of molecular and immune treatments for hepatocellular carcinoma. Nature reviews Gastroenterology \u0026amp; hepatology. 2021;18(5):293\u0026ndash;313.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgirrezabal I, Bouattour M, Pinato DJ, D'Alessio A, Brennan VK, Carion PL, et al. Efficacy of transarterial radioembolization using Y-90 resin microspheres versus atezolizumab-bevacizumab in unresectable hepatocellular carcinoma: A matching-adjusted indirect comparison. European Journal of Cancer. 2024;196:113427.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMakary MS, Bozer J, Miller ED, Diaz DA, Rikabi A. Long-term clinical outcomes of Yttrium-90 transarterial radioembolization for hepatocellular carcinoma: a 5-year institutional experience. Academic Radiology. 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSingal AG, Llovet JM, Yarchoan M, Mehta N, Heimbach JK, Dawson LA, et al. AASLD practice guidance on prevention, diagnosis, and treatment of hepatocellular carcinoma. Hepatology. 2023:10.1097.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLevillain H, Bagni O, Deroose CM, Dieudonn\u0026eacute; A, Gnesin S, Grosser OS, et al. International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres. European journal of nuclear medicine and molecular imaging. 2021;48:1570\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalem R, Padia SA, Lam M, Chiesa C, Haste P, Sangro B, et al. Clinical, dosimetric, and reporting considerations for Y-90 glass microspheres in hepatocellular carcinoma: updated 2022 recommendations from an international multidisciplinary working group. European Journal of Nuclear Medicine and Molecular Imaging. 2023;50(2):328\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu DM, Leung TW, Chow PK, Ng DC, Lee R-C, Kim YH, et al. Clinical consensus statement: Selective internal radiation therapy with yttrium 90 resin microspheres for hepatocellular carcinoma in Asia. International Journal of Surgery. 2022;102:106094.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiller FH, Lopes Vendrami C, Gabr A, Horowitz JM, Kelahan LC, Riaz A, et al. Evolution of radioembolization in treatment of hepatocellular carcinoma: a pictorial review. RadioGraphics. 2021;41(6):1802\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHien PN, Chun HJ, Oh JS, Kim SH, Choi BG. Arterial-Portal Venous Shunt after Drug-Eluting Bead Transarterial Chemoembolization for Hepatocellular Carcinoma Patients: Risk factors and Impact on Patient Survival. Oncology. 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCho Y, Choi JW, Kwon H, Kim KY, Lee BC, Chu HH, et al. Transarterial chemoembolization for hepatocellular carcinoma: 2023 expert consensus-based practical recommendations of the Korean Liver Cancer Association. Journal of Liver Cancer. 2023;23(2):241\u0026ndash;61.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalem R, Gabr A, Riaz A, Mora R, Ali R, Abecassis M, et al. Institutional decision to adopt Y90 as primary treatment for hepatocellular carcinoma informed by a 1,000-patient 15‐year experience. Hepatology. 2018;68(4):1429\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl Fouly A, Ertle J, El Dorry A, Shaker MK, Dech\u0026ecirc;ne A, Abdella H, et al. In intermediate stage hepatocellular carcinoma: radioembolization with yttrium 90 or chemoembolization? Liver International. 2015;35(2):627\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGardini AC, Tamburini E, I\u0026ntilde;arrairaegui M, Frassineti GL, Sangro B. Radioembolization versus chemoembolization for unresectable hepatocellular carcinoma: a meta-analysis of randomized trials. OncoTargets and therapy. 2018:7315\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEgger ME, Armstrong E, Martin RC, Scoggins CR, Philips P, Shah M, et al. Transarterial chemoembolization vs radioembolization for neuroendocrine liver metastases: a multi-institutional analysis. Journal of the American College of Surgeons. 2020;230(4):363\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eElhanafy E, Aboelinin M, Said R, Elmahdy Y, Aboelenin A, Fouad A, et al. Outcomes of liver resection for huge hepatocellular carcinoma exceeding 10 cm in size: A single center experience. The American Journal of Surgery. 2023;225(6):1013\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu SCH, Hui JW-Y, Li L, Cho CC-M, Hui EP, Chan SL, et al. Comparison of chemoembolization, radioembolization, and transarterial ethanol ablation for huge hepatocellular carcinoma (\u0026ge;\u0026thinsp;10 cm) in tumour response and long-term survival outcome. CardioVascular and Interventional Radiology. 2022:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhu S-L, Zhong J-H, Ke Y, Ma L, You X-M, Li L-Q. Efficacy of hepatic resection vs transarterial chemoembolization for solitary huge hepatocellular carcinoma. World Journal of Gastroenterology: WJG. 2015;21(32):9630.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang J, Huang W, Zhan M, Guo Y, Liang L, Cai M, et al. Drug-eluting bead transarterial chemoembolization combined with FOLFOX-based hepatic arterial infusion chemotherapy for large or huge hepatocellular carcinoma. Journal of hepatocellular carcinoma. 2021:1445\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"abdominal-radiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aima","sideBox":"Learn more about [Abdominal Radiology](http://link.springer.com/journal/261)","snPcode":"261","submissionUrl":"https://submission.springernature.com/new-submission/261/3","title":"Abdominal Radiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Large Hepatocellular Carcinoma, Transarterial Chemoembolization, Radioembolization","lastPublishedDoi":"10.21203/rs.3.rs-4603096/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4603096/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to compare transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) as first-line treatments for unresectable HCC\u0026thinsp;\u0026gt;\u0026thinsp;8 cm.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective study analyzed 129 HCC patients with tumor diameters greater than 8 cm from January 2010 to December 2021, including 40 patients who received TARE and 89 patients treated with TACE as primary treatment. Following Propensity Score Matching (PSM), 40 patients from each group were harmonized for baseline characteristics. Tumor responses were evaluated using mRECIST criteria, and survival outcomes were compared between treatment groups using Kaplan-Meier curves and the Log-rank test.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThere was no significant difference in the objective response rate (ORR) and disease control rate (DCR) at 3, 6, and 12 months between the two groups; ORR and DCR were 72.6%, 83.1% in TACE group vs 72.5%. 87.5% in TARE group for best tumor response (p-values: 0.625 and 0.981, respectively). Overall survival (OS) and progression-free survival (PFS) between the two groups were comparable pre- and post-PSM. After PSM, the OS was 33.2 months (20.0-58.6) in TACE group and 38.1 months (13.8\u0026ndash;98.1) in TARE group (p\u0026thinsp;=\u0026thinsp;0.53), while PFS was 11.5 months (7.7\u0026ndash;18.4) and 9.1 months (5.2\u0026ndash;23.8) respectively. After PSM, post-embolization syndrome developed more in TACE group (100% vs. 75%, p\u0026thinsp;=\u0026thinsp;0.002). Major adverse events were 72% in TACE group vs. 5% in TARE group (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eTARE and TACE offer comparable efficacy in managing large HCC, with TARE providing a safer profile, suggesting its consideration as a preferable initial therapeutic approach for unresectable HCC patients with tumors larger than 8 cm.\u003c/p\u003e","manuscriptTitle":"Comparison of Transarterial Chemoembolization vs Radioembolization for Large Unresectable Hepatocellular Carcinoma (\u0026gt;8cm): A Propensity Score Matching Analysis.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 16:06:31","doi":"10.21203/rs.3.rs-4603096/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-20T20:23:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-20T14:03:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-20T13:36:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191983870889693210672493234292839659813","date":"2024-08-09T10:45:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"292277585193574512317866283646630541043","date":"2024-08-09T02:21:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211042074080837387645127335523722160946","date":"2024-08-06T23:41:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-29T12:36:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"123520003820206861629373548058092568434","date":"2024-07-23T04:07:19+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-20T20:34:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-20T03:10:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-20T03:10:22+00:00","index":"","fulltext":""},{"type":"submitted","content":"Abdominal Radiology","date":"2024-06-19T04:23:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"abdominal-radiology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"aima","sideBox":"Learn more about [Abdominal Radiology](http://link.springer.com/journal/261)","snPcode":"261","submissionUrl":"https://submission.springernature.com/new-submission/261/3","title":"Abdominal Radiology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"e23e1fe8-9dc9-4966-a368-c2f36d59f5d0","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-30T16:04:35+00:00","versionOfRecord":{"articleIdentity":"rs-4603096","link":"https://doi.org/10.1007/s00261-024-04573-5","journal":{"identity":"abdominal-radiology","isVorOnly":false,"title":"Abdominal Radiology"},"publishedOn":"2024-09-25 15:57:48","publishedOnDateReadable":"September 25th, 2024"},"versionCreatedAt":"2024-07-18 16:06:31","video":"","vorDoi":"10.1007/s00261-024-04573-5","vorDoiUrl":"https://doi.org/10.1007/s00261-024-04573-5","workflowStages":[]},"version":"v1","identity":"rs-4603096","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4603096","identity":"rs-4603096","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}