PURPOSE: To assess safety, and outcomes of transarterial hepatic embolization(TAE) and Yttrium-90 radioembolization (TARE) in treating patients with large (>
7cm) hepatocellular carcinoma (HCC). METHODS AND MATERIALS: Treatment-naive patients with HCC >
7cm who were treated with TAE or TARE between January 2013 to December 2023 were reviewed in this retrospective study. Nearest neighbor 2:1 propensity score matching was utilized for direct comparison. Radiological treatment response was assessed using mRECIST. Kaplan-Meier survival curves were used to estimate progression-free (PFS) and overall survival (OS). Log-rank tests were performed to compare survival curves. RESULTS: A total of 125 patients with HCC>
7 cm were treated with TAE (n=103) or TARE (n=22). After propensity score matching, 44 patients who underwent TAE and 22 patients that were treated with TARE were compared. The mean tumor size was 10.4±2.6cm (TAE) and 10.7±2.7cm (TARE) (p>
0.695). TAE and TARE exhibited comparable adverse event rates (Grade 1 AE in 22/44 (50%) in TAE and 6/22 (27%) in TARE
p=0.999
One grade 2 (4.5%)AE in TAE. Median OS was 15.2 and 23.6 months in the TAE and TARE groups, respectively (p=0.252). Median local progression-free survival (LPFS
4.7 vs 21.6 months, p<
0.001) and PFS (3.6 vs 10.0 months, p=0.002) were significantly longer after TARE. TAE and TARE had similar objective response rates (TAE=88.6% vs TARE = 77.3%, p=0.364). Systemic therapy after TAE or TARE was a significant positive prognostic factor associated with disease progression and survival (PFS, HR=0.58, p=0.047
OS, HR=0.33, p<
0.001). CONCLUSION: TAE and TARE are both safe transarterial therapies for patients with HCC >
7 cm. TARE is associated with a longer time to progression and longer OS.