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Korean J Gastroenterol  <  Volume 75(3); 2020 <  Articles

Korean J Gastroenterol 2020; 75(3): 147-156  https://doi.org/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
Kang Hyun Park, Jeong Han Kim , Won Hyeok Choe, So Young Kwon, Byung Chul Yoo, Jin Ho Hwang1, Sang Woo Park1, Young Jun Kim1, Hee Sun Park1, Mi Hye Yu1 and Hae Jeong Jeon1
Departments of Internal Medicine and Radiology1, Konkuk University School of Medicine, Seoul, Korea
Correspondence to: Jeong Han Kim, Department of Internal Medicine, Konkuk University School of Medicine, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea. Tel: +82-2-2030-7764, Fax: +82-2-2030-5029, E-mail: 93haan@hanmail.net, ORCID: https://orcid.org/0000-0002-8383-8524

Financial support: This paper was supported by Konkuk University in 2019.
Received: October 22, 2019; Revised: February 10, 2020; Accepted: February 10, 2020; Published online: March 25, 2020.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Keywords: Carcinoma, hepatocellular; Chemoembolization, therapeutic


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