Background : Transarterial chemoembolization (TACE) and percutaneous acetic acid injection (PAI) are effective loco-regional therapies for hepatocellular carcinoma (HCC).

Aim : To compare the therapeutic efficacy of TACE vs. PAI for unresectable HCC.

Methods : A total of 310 patients with unresectable HCCs (size ≤6 cm) undergoing TACE (n = 195) or PAI (n = 115) were studied prospectively. Overall and progression-free survivals were measured endpoints.

Results : The overall survival was not significantly different between the two groups (P = 0.508). Among 129 patients with large (3.1–6 cm) HCCs, the overall survival was significantly better for the TACE group (P = 0.018). Cox multivariate analysis showed that Child-Pugh B [relative risk (RR): 4.2, 95% confidence interval (CI): 2.3–7.7, P < 0.001] and PAI therapy (RR: 1.4, 95%: 1.0–1.9, P = 0.057) were poor prognostic predictors; the progression-free survival was also significantly better in the TACE group (P = 0.038). Among 181 patients with small (≤3 cm) HCCs, there was no significant difference of overall survival (P = 0.265) or progression-free survival (P = 0.146) between the two groups; Child-Pugh B was the only prognostic factor predicting a decreased survival (RR: 2.8, 95% CI: 1.7–4.8, P < 0.001).

Conclusions : Patients with large HCC undergoing TACE tend to have a more favourable long-term outcome. For small HCC, either TACE or PAI therapy could be recommended as the primary treatment modality.