Abstract: Objective To investigate the efficiency and safety of transcatheter arterial chemoembolization (TACE) combined with percutaneous ethanol injection (PEI) in patients with primary liver cancer (PLC). Methods Total of 57 cases of PLC patients were divided into combination therapy group (TACE ＋ PEI, 30 cases) and control group (TACE alone, 27 cases) randomly. Combination therapy group was treatment in DSA downward showed immediate with conventional ultrasound and DSA guided fine needle PEI. Control group was treatment by conventional TACE treat. Results No major complication occurred except for moderate pain in 18 cases in combination treatment group. No significant difference between combination therapy group and control group in terms of occurrence of postoperative fever, liver and kidney injury, blood test abnormalities, and abnormal prothrombin time (all P ＞ 0.05). The overall response rate (complete response and partial response, CR ＋ PR ) in the combination therapy group was 83.3% (25/30), whereas in control group, it was 55.6% (15/27). The 12-month survival rate for the combination therapy group was 86.7%, which was significantly higher than that in control group (63%) (P ＜ 0.05). Conclusions Compared to TACE alone, combination of TACE and PEI demonstrated a better 12-month survival rate with similar safety profile in PLC patients.