Background:Transarterial radioembolization (TARE) with Yttrium-90 microspheres is an established therapy for unresectable hepatocellular carcinoma (HCC). However, its clinical efficacy compared to transarterial chemoembolization (TACE) remains unclear.Methods:We retrospectively reviewed 279 consecutive patients undergoing TARE (n = 104) or TACE (n = 175) at four tertiary centers. Patients with metastatic disease, locally advanced HCC, or Child–Pugh (CP) C were excluded. Data on treatment, adverse events, survival outcomes (median overall survival [mOS], and objective response rates [by modified Response Evaluation Criteria in Solid Tumors; mRECIST]) were collected.Results:The median follow-up of the cohort was 27 months (IQR 13–50), the mean age was 67.6 ± 10.1 years, and 207 (74.2%) were male. The cohort was balanced in age, performance status, CP class, and HCC etiology. Maximum tumor diameter was significantly larger in the TARE cohort compared to the TACE cohort (4.4 vs. 3.1 cm,p< 0.001), including within the BCLC 0/A (4.2 vs. 2.7 cm,p= 0.001) and BCLC B (5.0 vs. 4.0 cm,p= 0.049) subgroups. The mOS was longer with TACE (37 vs. 22 months; hazard ratio [HR] 1.65, 95% CI: 1.19–2.29,p= 0.002). In BCLC 0/A patients, TACE yielded longer mOS (60 vs. 25 months; HR 2.35, 95% CI: 1.17–4.69;p= 0.016). In BCLC B, mOS was longer with TACE (32 vs. 20 months), but was not statistically significant (HR 1.39, 95% CI: 0.96–2.03,p= 0.080). In BCLC 0/A, complete response rates were higher with TACE (43.2% vs. 34.3%,p= 0.012). Hepatic decompensation was more frequent with TARE- (26.0%) than with TACE-treated patients (13.7%,p= 0.010).Conclusions:TACE demonstrated superior survival outcomes over TARE, particularly in early-stage disease. These results advocate for a more nuanced selection of embolization therapies in these patients.
背景：钇-90微球经动脉放射栓塞术（TARE）已成为不可切除肝细胞癌（HCC）的成熟疗法，但其与经动脉化疗栓塞术（TACE）的临床疗效对比尚不明确。 方法：本研究回顾性分析了四家三级医疗中心连续收治的279例患者，其中104例接受TARE治疗，175例接受TACE治疗。排除转移性疾病、局部晚期HCC及Child-Pugh（CP）C级患者。收集治疗相关数据、不良事件及生存结局（中位总生存期[mOS]、基于改良实体瘤疗效评价标准[mRECIST]的客观缓解率）。 结果：队列中位随访时间为27个月（四分位距13-50个月），平均年龄67.6±10.1岁，男性207例（74.2%）。两组患者在年龄、体能状态、CP分级及HCC病因方面均衡。TARE组最大肿瘤直径显著大于TACE组（4.4 cm vs. 3.1 cm，p<0.001），该差异在BCLC 0/A亚组（4.2 cm vs. 2.7 cm，p=0.001）和BCLC B亚组（5.0 cm vs. 4.0 cm，p=0.049）中均存在。TACE组mOS更长（37个月 vs. 22个月；风险比[HR] 1.65，95%置信区间：1.19-2.29，p=0.002）。在BCLC 0/A患者中，TACE组mOS显著延长（60个月 vs. 25个月；HR 2.35，95%置信区间：1.17-4.69，p=0.016）。BCLC B患者中TACE组mOS更长（32个月 vs. 20个月），但无统计学显著性（HR 1.39，95%置信区间：0.96-2.03，p=0.080）。BCLC 0/A患者中TACE组完全缓解率更高（43.2% vs. 34.3%，p=0.012）。TARE组肝功能失代偿发生率显著高于TACE组（26.0% vs. 13.7%，p=0.010）。 结论：TACE在生存结局方面优于TARE，尤其在早期疾病阶段。本研究结果提示需对此类患者的栓塞治疗策略进行更精细化的选择。
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