Korean J Gastroenterol.  2020 Mar;75(3):147-156. 10.4166/kjg.2020.75.3.147.

Risk Factors for Liver Function Deterioration after Transarterial Chemoembolization Refractoriness in Child-Pugh Class A Hepatocellular Carcinoma Patients

Affiliations
  • 1Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea. 93haan@hanmail.net
  • 2Department of Radiology, Konkuk University School of Medicine, Seoul, Korea.

Abstract

BACKGROUND/AIMS
A switch to systemic therapy, such as sorafenib, should be considered for hepatocellular carcinoma (HCC) patients refractory to transarterial chemoembolization (TACE). On the other hand, treatment changes are difficult if the liver function worsens to Child-Pugh B or C. Therefore, predicting the risk factors for non-responsiveness to TACE and deteriorating liver function may be helpful.
METHODS
Newly diagnosed Child-Pugh A HCC patients who underwent TACE from January 2012 to June 2018 were included. After 1 year, this study evaluated whether there was a treatment response to TACE and whether the Child-Pugh class had worsened.
RESULTS
Among 121 patients, 65 were refractory and 56 responded to TACE. In multivariable logistic regression analysis, the tumor size, tumor number, and albumin at the time of the diagnosis of HCC were significant prognostic factors for the treatment response to TACE. Among 65 patients who presented TACE-refractoriness, 27 showed liver function deterioration from Child-Pugh class A to class B or C after TACE. In multivariable logistic regression analysis, bilirubin at the diagnosis of HCC was a significant prognostic factor for liver function deterioration. A predictive algorithm based on the regression equations revealed a sensitivity, specificity, positive predictive value, and negative predictive value of 74.1%, 74.5%, 45.5%, and 90.9%, respectively, for TACE-refractoriness and liver function deterioration.
CONCLUSIONS
The prognostic model incorporating the tumor size, tumor number, albumin, and bilirubin at the diagnosis of HCC may help identify patients who show a poor response to TACE and aggravation of liver function after TACE, who may benefit from early switching into systemic therapy before liver function aggravation.

Keyword

Carcinoma, hepatocellular; Chemoembolization, therapeutic

MeSH Terms

Bilirubin
Carcinoma, Hepatocellular*
Chemoembolization, Therapeutic
Diagnosis
Hand
Humans
Liver*
Logistic Models
Risk Factors*
Sensitivity and Specificity
Bilirubin

Figure

  • Fig. 1. Patient flow diagram. HCC, hepatocellular carcinoma; TACE, transarterial chemoembolization; RFA, radiofrequency ablation.

  • Fig. 2. ROC curves and equations of the multivariable logistic regression of TACE refractoriness. AUC, area under the curve; HCC, hepatocellular carcinoma; Alb, albumin; ROC, receiver operating characteristic; TACE, transarterial chemoembolization.

  • Fig. 3. Total bilirubin ROC curves of the univariable logistic regression of liver function deterioration. AUC, area under the curve; ROC, receiver operating characteristic.

  • Fig. 4. Prediction of patients with reduced liver function without a response after TACE using the regression formula. HCC, hepatocellular carcinoma; TACE, transarterial chemoembolization.


Reference

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