Liver failure after transarterial chemoembolization for patients with hepatocellular carcinoma and ascites: incidence, risk factors, and prognostic prediction.

Abstract

BACKGROUND:

Transarterial chemoembolization (TACE) is widely used in patients with hepatocellular carcinoma (HCC). Post-TACE liver failure may occur, especially in patients with poor hepatic reserve. Ascites is often present in patients with HCC with coexisting cirrhosis. This study investigated the incidence, risk factors, and prognostic predictors in patients with HCC and ascites receiving TACE.

METHODS:

A total of 614 patients with HCC were enrolled and analyzed. Liver failure was defined as an increase of serum bilirubin level (≥2.0 mg/dL), increasing or newly developed ascites, or hepatic encephalopathy within 2 weeks of TACE.

RESULTS:

Ascites that were present in 100 (16.2%) patients at study entry, independently predicted a poor prognosis in the Cox proportional hazard model [relative risk (RR)=1.75, P=0.004]. Post-TACE liver failure occurred in 17 (17.3%) of 98 patients with HCC who had ascites and long-term follow-up. Child-Turcotte-Pugh class B (odds ratio=10.1, P=0.038) and post-TACE gastrointestinal bleeding (odds ratio=10.86, P=0.006) were independent risk factors associated with liver failure in the multivariate analysis. Of the 17 patients with post-TACE liver failure, 16 (94%) died within the first year of treatment. Liver failure (RR: 2.13, P=0.029), serum α-fetoprotein level >51 ng/mL (RR=2.0, P=0.013) and poor performance status (RR: 2.17, P=0.003) independently predicted a poor prognosis in patients with ascites receiving TACE.

CONCLUSIONS:

Preexisting ascites increases the mortality in patients with HCC receiving TACE. In patients with HCC and ascites, Child-Turcotte-Pugh class B and gastrointestinal bleeding are associated with liver failure after TACE. Post-TACE liver failure is a common event and predicts a decreased survival in patients with HCC and ascites.

• Authors: I-Fang Hsin, Chia-Yang Hsu, Hui-Chun Huang, Yi-Hsiang Huang, Han-Chieh Lin, Rheun-Chuan Lee, Jen-Huey Chiang, Fa-Yauh Lee, Teh-Ia Huo, Shou-Dong Lee
• Journal: Journal of clinical gastroenterology (J Clin Gastroenterol) Vol. 45 Issue 6 Pg. 556-62 (Jul 2011) ISSN: 1539-2031 [Electronic] United States
• PMID: 21666547 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antineoplastic Agents

Topics

• Aged
• Antineoplastic Agents (therapeutic use)
• Ascites (complications, epidemiology, mortality, therapy)
• Carcinoma, Hepatocellular (complications, epidemiology, mortality, therapy)
• Chemoembolization, Therapeutic (methods)
• Female
• Humans
• Incidence
• Liver Failure (epidemiology, etiology, mortality, pathology)
• Liver Neoplasms (complications, epidemiology, mortality, therapy)
• Male
• Middle Aged
• Predictive Value of Tests
• Prognosis
• Risk Factors
• Survival Analysis