The Role of TARE for Bridging and Downstaging of HCC Before Resection or Liver Transplant

Background: Hepatocellular carcinoma (HCC) remains a major cause of cancer-related mortality, with many patients initially unsuitable for curative resection or transplantation. Transarterial radioembolization (TARE) has emerged as a locoregional therapy to downstage tumors and expand surgical eligibility. Methods: This retrospective study included 25 patients with HCC who underwent TARE as a bridging treatment. The primary outcomes assessed were the efficacy of TARE in facilitating curative surgery and long-term oncological outcomes, specifically overall survival (OS) and disease-free survival (DFS). Results: Seventeen patients subsequently underwent surgical resection and eight underwent living donor liver transplantation (LDLT). At a median follow-up of 33.4 months, the median DFS was 11.2 months, with patients experiencing recurrence showing significantly shorter DFS (3.65 months) than those without recurrence (27.1 months). Median OS for the cohort was 33.4 months, with 76% of patients alive and disease-free at last follow-up. Kaplan–Meier analysis demonstrated sustained OS in the LDLT group, while resection patients gradually declined within the first two years. Conclusion: TARE is an effective bridging strategy that enables curative-intent surgery in selected patients with HCC and supports favorable long-term oncological outcomes. Careful patient selection and multidisciplinary management remain essential to optimize survival benefits.