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Purpose: To present the early results of pirarubicin-eluting microsphere transarterial chemoembolization (PETACE) for patients with unresectable hepatocellular carcinoma (HCC).Materials and methods: We retrospectively analyzed 55 consecutive patients with HCC who received PE-TACE between April 1,2015 and August 30,2016.The complication rate,tumor response rate,progression-free survival (PFS),and overall survival (OS) were analyzed.Results: Adverse events were generally mild and included abdominal pain and fever,although a major complication was reported in 1 patient (1.8％).During a median follow-up of 10.0 months (range,3.0-24.0 months),14 patients (25.5％) achieved a complete tumor response,25 (45.5％) had a partial response,9 (16.4％) showed stable disease,and 7 (12.7％) had disease progression.The 1-month overall response rate was 70.9％,and the local tumor response rate was 89.0％.The 1-month tumor response rate was 100％ for Barcelona Clinic Liver Cancer (BCLC) stage A or B disease and 62.8％ for BCLC stage C disease.The median PFS was 6.1 months (95％confidence interval[95％CI],3.4-8.8 months;range,1.0-24.0 months).The median OS was 11.0 months (95％CI,7.1-14.9 months;range,2.0-24.0 months).Kaplan-Meier analysis (log-rank test) found significant differences in OS between patients grouped by tumor number (P =0.006),tumor size (P =0.035),and Easte Cooperative Oncology Group (ECOG) score (P =0.005).The tumor number (1 vs.≥2) was the only factor independently associated with OS (hazard ratio[HR],2.867;95％CI,1.330-6.181;P-0.007).Conclusions: PE-TACE for unresectable HCC may be safe,with favorable tumor response rates and survival time,especially in patients with a single large tumor.Longer follow-up using a larger series is necessary to confirm these preliminary results.