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Given the lack of specific recommendations for conventional TACE (cTACE) and drug\u2010eluting bead TACE (DEB\u2010TACE) in patients having unresectable HCC with tumor infiltrating the common hepatic duct or the first\u2010order branch of the bile ducts (B1\u2010type bile duct invasion; B1\u2010BDI) after biliary drainage, we retrospectively compared the safety and efficacy of DEB\u2010TACE with cTACE in this patient population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Using data from five tertiary medical centers (January 2017\u2013December 2021), we compared complications, overall survival (OS), time to progression (TTP), and tumor response rate between patients having unresectable HCC with B1\u2010BDI who underwent DEB\u2010TACE or cTACE after successful biliary drainage. X\u2010tile software calculated the pre\u2010TACE total bilirubin (TBil) cutoff value, indicating optimal timing for sequential TACE after drainage. Propensity score matching (PSM) was performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study included 108 patients with unresectable HCC (B1\u2010BDI) who underwent DEB\u2010TACE and 114 who received cTACE as initial treatment. After PSM (<jats:italic>n<\/jats:italic>\u2009=\u200953 for each group), the DEB\u2010TACE group had a longer TTP (8.9 vs. 6.7\u2009months, <jats:italic>p<\/jats:italic>\u2009=\u20090.038) and higher objective response rate (64.2% vs. 39.6%, <jats:italic>p<\/jats:italic>\u2009=\u20090.011) than did the cTACE group, although OS was comparable (16.7 vs. 15.3\u2009months, <jats:italic>p<\/jats:italic>\u2009=\u20090.115). The DEB\u2010TACE group exhibited fewer post\u2010procedural increments in the mean albumin\u2010bilirubin score, TBil, and alanine aminotransferase (ALT), along with a significantly lower incidence of serious adverse events within 30\u2009days (hepatic failure, ALT increase, and TBil increase) than the cTACE group (all <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05). The pre\u2010TACE TBil cutoff value was 99\u2009\u03bcmol\/L; patients with higher values (&gt;99\u2009\u03bcmol\/L) had poorer OS in both groups (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>DEB\u2010TACE is safe and effective after successful biliary drainage in unresectable HCC with B1\u2010BDI, potentially better than cTACE in terms of liver toxicity, TTP, and ORR. Lowering TBil below 99\u2009\u03bcmol\/L through successful drainage may create ideal conditions for sequential TACE.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.7419","type":"journal-article","created":{"date-parts":[[2024,7,6]],"date-time":"2024-07-06T07:40:15Z","timestamp":1720251615000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["<scp>DEB<\/scp>\u2010<scp>TACE<\/scp> versus <scp>cTACE<\/scp> for unresectable <scp>HCC<\/scp> with <scp>B1<\/scp>\u2010type bile duct invasion after successful biliary drainage: A propensity score matching analysis"],"prefix":"10.1002","volume":"13","author":[{"given":"Wenzhe","family":"Fan","sequence":"first","affiliation":[{"name":"Department of Interventional Oncology The First Affiliated Hospital of Sun Yat\u2010sen University  Guangzhou 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