Real-World Efficacy of Transarterial Embolization and Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma: a Nationwide Cohort Study in Taiwan

<b>Purpose:</b> Locoregional therapies, such as transarterial embolization (TAE) and transarterial chemoembolization (TACE), are central to the treatment of unresectable hepatocellular carcinoma (HCC), particularly at the intermediate stage. However, there have been few large-scale real-world data comparisons of their effectiveness with that of systemic therapies. This study aimed to assess the relationships between different treatment modalities and all-cause mortality in a nationwide HCC cohort. <b>Patients and methods:</b> We used the Taiwan National Health Insurance Research Database to recruit and identify 225,631 patients diagnosed with HCC between 2008 and 2021. The analyzed treatment modalities included hepatic resection, chemotherapy, targeted therapy, immunotherapy, TAE, and TACE. Cox proportional hazards models were applied to analyze the adjusted hazard ratios (HRs) for mortality. <b>Results:</b> Both TAE (HR: 0.17) and TACE (HR: 0.17) were independently associated with significantly reduced mortality (<i>p</i> < 0.0001). In contrast, targeted therapy (HR: 6.17) and immunotherapy (HR: 5.84) were associated with increased mortality, probably because the selected patients had more advanced diseases. Older age and male sex were also independently associated with worse outcomes. There was no significant association between chemotherapy and mortality. <b>Conclusion:</b> In this large, population-based, real-world cohort, TAE and TACE were significantly associated with better survival in patients with unresectable HCC, supporting their continued use as standard-of-care treatments in appropriately selected patients. The results highlight the need for multidisciplinary approaches to optimize advanced HCC outcomes.