Hepatic dysfunction limits the therapeutic options for hepatocellular carcinoma (HCC), which is closely associated with patient prognosis. Established practice guidelines for patients with HCC and impaired liver function are lacking. The treatment allocation in these populations is heterogeneous and remains controversial. This study compared the survival benefits of liver resection (LR) and transarterial chemoembolisation (TACE) in patients with HCC and impaired liver function.

Inclusion Criteria:

• patients with HCC who received conventional LR or TACE

Exclusion Criteria:

• （1） presence of portal vein tumour thrombosis (PVTT), hepatic artery, biliary duct or inferior vena cava invasion
• （2） extrahepatic spread (EHS)
• （3） albumin-bilirubin grade 1 or 3
• （4） Eastern Cooperative Oncology Group Performance Status (ECOG-PS) >1
• （5） tumour number >3
• （6） other tumours or severe cardiac, cerebral, and renal insufficiency
• （7）ascites, hepatic encephalopathy, and jaundice

Study data were extracted from a nationwide database of patients with HCC treated at 15 Chinese centres between January 2012 and December 2022.We included patients who were diagnosed with HCC according to the American Association for the Study of the Liver Disease/European Association for the Study of the Liver Guidelines and who received conventional LR or TACE