Conventional vs. Drug-Eluting Beads Transarterial Chemoembolization for Unresectable Hepatocellular Carcinoma—A Propensity Score Weighted Comparison of Efficacy and Safety

SIMPLE SUMMARY: Transarterial chemoembolization (TACE) is a guideline-approved, minimally invasive therapy for unresectable hepatocellular carcinoma (HCC). This study investigated the efficacy and safety of two frequently performed types of TACE that are currently used interchangeably. The statistical method of propensity score weighting was used to reduce bias in the results based on baseline differences and make the groups as comparable as possible. In a large cohort of 370 HCC patients, no significant difference in overall survival was observed between the two TACE groups and adverse advents occurred with similar frequency in both groups. However, conventional TACE showed superior efficacy in patients with infiltrative disease, whereas drug-eluting beads TACE was more effective in nodular tumors. These findings suggest that tumor morphology and distribution on baseline imaging can inform decisions on the type of TACE that the individual patient would benefit from the most. ABSTRACT: This study compared the efficacy and safety of conventional transarterial chemoembolization (cTACE) with drug-eluting beads (DEB)-TACE in patients with unresectable hepatocellular carcinoma (HCC). This retrospective analysis included 370 patients with HCC treated with cTACE (n = 248) or DEB-TACE (n = 122) (January 2000–July 2014). Overall survival (OS) was assessed using uni- and multivariate Cox proportional hazards models and Kaplan-Meier analysis. Additionally, baseline imaging was assessed, and clinical and laboratory toxicities were recorded. Propensity score weighting via a generalized boosted model was applied to account for group heterogeneity. There was no significant difference in OS between cTACE (20 months) and DEB-TACE patients (24.3 months, ratio 1.271, 95% confidence interval 0.876–1.69; p = 0.392). However, in patients with infiltrative disease, cTACE achieved longer OS (25.1 months) compared to DEB-TACE (9.2 months, ratio 0.366, 0.191–0.702; p = 0.003), whereas DEB-TACE proved more effective in nodular disease (39.4 months) than cTACE (18 months, ratio 0.458, 0.308–0681; p = 0.007). Adverse events occurred with similar frequency, except for abdominal pain, which was observed more frequently after DEB-TACE (101/116; 87.1%) than cTACE (119/157; 75.8%; p = 0.02). In conclusion, these findings suggest that tumor morphology and distribution should be used as parameters to inform decisions on the selection of embolic materials for TACE for a more personalized treatment planning in patients with unresectable HCC.