Predictors of outcome of transarterial locoregional therapies in unresectable hepatocellular carcinoma: a multicenter analysis

Abstract Objectives Unresectable hepatocellular carcinoma (uHCC) is characterized by variable outcomes following embolization therapies. We aimed to identify predictors of survival and disease control (DC) in non-metastatic uHCC undergoing transarterial chemoembolization (TACE) or radioembolization (TARE). Methods This multicenter, retrospective study reviewed patient, tumor, and treatment-related data; time-to-event median overall survival (mOS), and DC rates assessed by modified Response Evaluation Criteria in Solid Tumors (mRECIST) were collected over a median follow-up duration of 24 (IQR 11–42) months. Results Of 312 patients, 73.1 % were male, with a mean age of 67.1 ± 10.1 years; the majority were BCLC B (54.5 %), followed by 0/A (34.0 %) and locally advanced C (11.5 %). The mOS was longer in BCLC 0/A (47 months) than B (30 months) and C patients (22 months; p=0.0002). Patients treated with TACE had longer mOS of 43.0 months (95 % CI: 32.0–50.0) vs. 30.0 months (95 % CI: 19.0–32.0) for TARE (HR: 0.61, 95 % CI: 0.46–0.82; p=0.0011). Multivariable analyses revealed age (aHR: 0.97, 95 % CI: 0.94–0.99; p=0.015), beyond up-to-seven criteria (aHR: 2.21, 95 % CI: 1.17–4.17; p=0.014), BCLC stage (0/A vs. B; aHR: 2.20, 95 % CI: 1.27–3.83; p=0.005), post-intervention hepatic decompensation (aHR: 3.29, 95 % CI: 1.52–7.10; p=0.022), and treatment response (aHR: 2.78, 95 % CI: 1.30–5.94; p=0.008) as independent predictors of survival. TACE yielded higher complete response rates (33.5 % vs. 23.3 %; p=0.049), but similar DC (80.9 % vs. 76.7 %, p=0.567) to TARE. Predictors of DC included AFP level (≥400 ng/mL; aOR: 0.31, 95 % CI: 0.16–0.63; p=0.001) and BCLC stage (0/A vs. C, aOR: 0.20, 95 % CI: 0.08–0.53; p=0.001). Conclusions TACE achieved higher complete response rates but did not independently predict superior survival over TARE in uHCC patients. Patient-related factors rather than modality of intervention predicted treatment outcomes, underscoring their role in patient selection for embolization therapies.