Segmental versus subsegmental transarterial chemoembolization (TACE) for small (< 3 cm) hepatocellular carcinoma (HCC): Less selective, more effective? A propensity score-matched analysis

Objectives: To compare segmental (s-) and subsegmental (ss-) transarterial chemoembolization (TACE) for small hepatocellular carcinoma (HCC), in terms of early complete response (CR), local tumor progression (LTP) and impact on hepatic function (ALBI score). Materials and methods: A single-center retrospective study was conducted on consecutive patients who underwent s-TACE or ss-TACE as exclusive treatment for small (< 3 cm) HCC between 2021 and 2023. The primary endpoints were 1-month CR and LTP rate during follow-up. The effect of the treatments on hepatic function, as assessed by the ALBI score, was analyzed as a secondary endpoint. Propensity score matching (PSM), based on both baseline and procedural data, was applied to minimize selection bias. Results: Eighty-nine patients with a total of 114 lesions were enrolled in a per-lesion analysis. No significant differences were found in terms of 1-month CR (74% vs.83%, p = 0.24). Twenty-five transplanted patients were censored at the date of transplantation. During a median follow-up of 16 months (range 7–28 months), ssTACE showed a significantly higher LTP rate compared to sTACE (38% vs. 7.5%, p = 0.001). The results were confirmed after applying PSM, with a hazard ratio of 4 (95% CI, 2–10) for LTP in the ssTACE group. The median time to LTP was similar for both groups (6.7 months vs. 5.6 months, p = 0.92). No differences were observed regarding the worsening of liver function. Conclusions: Despite similar early CR rates, ssTACE showed a significantly higher LTP rate compared to sTACE, with no significant differences in liver function deterioration between the two approaches.