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Of the 16 patients without vascular invasion, 8 (50.0%) had TP53 mutations, and TP53 mutation was associated with TACE failure/refractoriness (p=0.041). Moreover, GSEA showed that MAPK and apoptosis pathways induced by TP53 mutation were possibly associated with TACE failure/refractoriness. Conclusion Our study suggested that TP53 mutation was independently related with TACE efficacy, which may work via MAPK and apoptosis pathways. These findings may provide evidence to help distinguish patients who will particularly benefit from TACE fro