Proton beam therapy versus trans-arterial chemoembolization for BCLC stage B hepatocellular carcinoma-a propensity-matched analysis.

Abstract

Purpose: Proton beam therapy (PBT) has a promising local control rate, but clinical data supporting its use for intermediate-stage hepatocellular carcinoma (HCC) remains insufficient, and its survival benefit over transarterial chemoembolization (TACE) has yet to be established. This study aimed to compare the two modalities by evaluating real-world survival outcomes.

Methods: The propensity score-matched (PSM) cohort study used data from a multi-institutional medical research database. Treatment-naïve patients with Barcelona Clinic Liver Cancer (BCLC) stage B HCC who underwent PBT or TACE as monotherapy were enrolled. Baseline patient and tumor characteristics were used for matching. Overall survival (OS) and post-treatment albumin-bilirubin (ALBI) grade were assessed, and stratified analyses were performed to evaluate the heterogeneity.

Results: Between January 2007 and December 2022, 4349 patients with BCLC‑B HCC were identified, 1172 of whom met the inclusion criteria (PBT: 68; TACE: 1104). The PSM cohort matched 340 patients (PBT: 68; TACE: 272). Cox regression analysis revealed a significant survival benefit in the PBT group (p = 0.032, hazard ratio (HR) 0.64, 95% CI 0.42-0.97). Liver function was assessed in terms of ALBI grade every 3 months for 12 months after treatment, and the proportion of patients who maintained better liver function was greater in the PBT group than in the TACE group (p = 0.006).

Conclusion: For patients with BCLC‑B HCC who are suitable candidates for PBT, PBT preserves better liver function than TACE and provides superior OS.