Predictors of hepatic decompensation after TACE for hepatocellular carcinoma
Mohamed A S Kohla1, Mai I Abu Zeid1, Mohamed Al-Warraky2
1Department of Hepatology , National Liver Institute, Menoufiya University , Shebeen El-Kom, Menoufiya , Egypt.
Insights
Lower serum albumin and higher alpha-fetoprotein (AFP) levels, along with larger tumor size, predict liver decompensation after transarterial chemoembolisation (TACE) for hepatocellular carcinoma (HCC). These factors aid in risk stratification for HCC patients undergoing TACE.
Area of Science:
- Hepatology
- Oncology
- Interventional Radiology
Background:
- Hepatocellular carcinoma (HCC) is a primary liver cancer.
- Transarterial chemoembolisation (TACE) is a common treatment for unresectable HCC.
- Predicting post-TACE hepatic decompensation is crucial for patient management.
Purpose of the Study:
- To identify factors that predict hepatic decompensation following TACE in HCC patients.
- To stratify HCC patients based on their risk of liver function decline post-TACE.
Main Methods:
- Prospective study of 102 patients with compensated cirrhosis and HCC undergoing TACE.
- Exclusion of patients with prior locoregional, systemic, or surgical therapy.
- Assessment of laboratory criteria, tumor characteristics (size, number), and Child-Pugh score at baseline and 1 month post-TACE.
- Classification into groups with and without decompensation (defined by Child-Pugh score increase).
- Univariate and multivariate analyses to determine predictive factors.
Main Results:
- Significant laboratory changes post-TACE included increased INR, bilirubin, AST, ALT, and decreased albumin and AFP.
- Univariate analysis identified lower baseline albumin, higher AFP, advanced BCLC stage, larger tumor size, and more nodules as significant predictors.
- Multivariate analysis confirmed larger tumor size, higher AFP, and lower albumin as independent predictors of decompensation.
- BCLC stage, nodule count, and pre-TACE bilirubin did not predict liver function changes.
Conclusions:
- Baseline lower serum albumin and increased tumor burden (larger size, more nodules, higher AFP) are key predictors of post-TACE hepatic decompensation.
- These findings can assist in identifying high-risk HCC patients before TACE.
- Risk stratification using these factors may optimize treatment decisions and patient monitoring.
Aim:
To study predictive factors for hepatic decompensation after transarterial chemoembolisation (TACE) for hepatocellular carcinoma (HCC).
Methods:
Between November 2009 and August 2010, of 254 patients with HCC who presented to our multidisciplinary HCC clinic for evaluation, 102 (40%) were amenable for TACE. In this prospective study, there were 102 patients with compensated cirrhosis with HCC and Child-Pugh Class A cirrhosis who underwent TACE at the National Liver Institute, Menoufiya University, Egypt. We excluded all patients with prior locoregional therapy, systemic therapy and/or surgical intervention. At baseline and at 1 month postprocedure, laboratory criteria, tumour criteria (size, number) and Child-Pugh score were recorded. Patients were classified into group 1 (no Child-Pugh point increase after TACE) and group 2 (one or more added Child-Pugh points after TACE, defining hepatic decompensation). Univariate and multivariate analyses were performed to identify factors predictive of hepatic decompensation.
Results:
Patients were mostly males (82.4%) of mean age 58.4±8.1 years. The only significant changes in laboratory findings at 1 month after TACE were increased international normalised ratio, serum total bilirubin, alanine transaminase and aspartate transaminase and decreased serum albumin and α-fetoprotein (AFP). The statistically significant predictive factors for hepatic decompensation using univariate analysis were found to be baseline lower serum albumin, higher serum α-fetoprotein, more advanced Barcelona Clinic Liver Cancer (BCLC) stage, larger tumour size and a greater number of tumour nodules; with logistic regression, multivariate analysis found that at baseline larger tumour size (p=0.004 at 95% CI), higher serum AFP (p=0.046 at 95% CI) and lower serum albumin (p=0.033 at 95% CI) predicted decompensation; BCLC stage, number of tumour nodules and pre-TACE bilirubin did not predict changes in liver function.
Conclusions:
Lower serum albumin and increased tumour burden (larger tumour size/more nodules and higher α-fetoprotein) at baseline may help predict post-TACE decompensation.
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