Transarterial Chemoembolization in Hepatocellular Carcinoma: Lessons from a 10-Year Real-World Retrospective Study

Gayane von Schoen-Angerer,1,* Guido Pesola,2,* Maria Luisa Garo,3 Gianluigi Marini,2,4 Stefano Cappio,4 Andreas Cerny,5 Lorenzo Magenta,5 Pietro Majno-Hurst,1,6 Lorenzo Bernardi,6 Marco Cefalì,2 Alessandra Cristaudi,6 Benedetta Terziroli Beretta-Piccoli,1,7 Elena Trevisi,2 Sara De Dosso1,2 1Faculty of Biomedical Sciences, University of Southern Switzerland (USI), Lugano, Switzerland; 2Medical Oncology Department, Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland; 3Mathsly Research, Biostatistics Unit, Rome, Italy; 4Clinic of Radiology, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland; 5Epatocentro Ticino, Lugano, Switzerland; 6Department of Surgery, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; 7Division of Gastroenterology and Hepatology, Ente Ospedaliero Cantonale (EOC) Lugano, Lugano, Switzerland*These authors contributed equally to this workCorrespondence: Sara De Dosso, Medical Oncology Department, Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), c/o Ospedale San Giovanni, Via A. Gallino 12, Bellinzona, CH-6500, Switzerland, Tel +41 091 811 9410, Email Sara.dedosso@eoc.chIntroduction: Transarterial chemoembolization, TACE continues to be the primary treatment option for patients diagnosed with intermediate-stage (BCLC B) hepatocellular carcinoma, HCC. However, emerging real-world evidence suggests that it may also be applicable for selected early-stage patients (BCLC A) who are not candidates for surgical resection or thermal ablation. This study aimed to evaluate the long-term outcomes of TACE within a large single-centre cohort.Methods: This retrospective observational cohort study included patients with HCC treated with TACE at Ente Ospedaliero Cantonale, EOC in Ticino, Switzerland between 2013 and 2023. The study was conducted and reported in accordance with the STROBE guidelines. Overall survival, OS and progression-free survival, PFS were estimated using Kaplan–Meier analysis and compared across Barcelona Clinic Liver Cancer, BCLC stages.Results: A total of 195 patients were included, with a median follow-up of 56 months. Most patients were classified as BCLC stage A (55.4%) or B (43.6%). Median OS for the entire cohort was 56 months. PFS was significantly longer in stage A compared with stage B patients (15 vs 9 months, p=0.003). Early modification of treatment within one month was associated with inferior outcomes, whereas patients who subsequently underwent curative-intent therapies achieved markedly prolonged survival.Conclusion: In this retrospective study, TACE demonstrated sustained tumour control and prolonged survival, exceeding the survival durations reported in previous studies (20– 42 months), particularly among early-stage HCC patients who were initially deemed unsuitable for resection or ablation. These findings emphasise the value of centralisation, multidisciplinary evaluation, tailored therapeutic approaches, and systematic periodic reassessment to optimise patient outcomes.Plain Language Summary: Hepatocellular carcinoma, HCC is the most common type of primary liver cancer. Many patients are not eligible for surgery, transplantation, or heat-based tumour ablation. In such situations, transarterial chemoembolization, TACE is frequently used. TACE delivers chemotherapy directly into the liver arteries supplying the tumour and blocks these blood vessels to reduce tumour blood flow.In this retrospective study, we evaluated real-world outcomes of TACE in a Swiss referral centre over a 10-year period (2013– 2023). We analysed medical records of 195 patients with HCC treated with TACE and followed them for a median of 56 months. Most patients had early-stage (BCLC A) or intermediate-stage (BCLC B) disease.Median overall survival for the entire cohort was 56 months. Cancer control lasted longer in early-stage disease: median progression-free survival was 15 months in BCLC A compared with 9 months in BCLC B. Patients requiring an early change of treatment within the first month after TACE tended to have worse outcomes. Importantly, patients who later received more effective treatments, including curative-intent options such as transplantation, surgery, or ablation, achieved very long survival.These findings suggest that TACE can provide durable tumour control and long-term survival, especially in carefully selected early-stage patients, and highlight the value of multidisciplinary care and regular reassessment over time.