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

Introduction: 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.