Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
J Clin Gastroenterol. 2010 Sep;44(8):e171-7. doi: 10.1097/MCG.0b013e3181c88235.
Renal dysfunction is often present in patients with cirrhosis and hepatocellular carcinoma (HCC). Acute renal failure (ARF) may occur after transarterial chemoembolization (TACE) owing to radiocontrast agent. This study investigated the incidence and risk factors of ARF and prognostic predictors in HCC patients with preexisting renal insufficiency undergoing TACE.
A total of 566 HCC patients undergoing TACE were enrolled. Renal insufficiency was defined as an estimated glomerular filtration rate less than 60 mL/min/1.73 m.
In a mean follow-up duration of 18+/-16 months, 231 (40.8%) patients undergoing TACE died. Renal insufficiency that was present in 134 (23.7%) patients at baseline, independently predicted a poor prognosis in the Cox proportional hazards model [risk ratio (RR): 1.47, P=0.012]. Of them, 13 (10%) and 6 (5%) patients had transient and prolonged ARF after TACE, respectively. Post-TACE gastrointestinal bleeding [odds ratio (OR): 16.54, P=0.001] and higher Cancer of the Liver Italian Program (CLIP) scores (> or =2; OR: 4.22, P=0.02) were independent risk factors for ARF in the multivariate logistic regression analysis. In the Cox model, prolonged ARF (RR: 3.28, P<0.001) and higher CLIP scores (> or =2; RR: 2.13, P<0.001) were independent poor prognostic predictors for HCC patients with renal insufficiency receiving TACE.
Gastrointestinal bleeding and higher CLIP scores are associated with the development of ARF in patients with HCC and renal insufficiency undergoing TACE. Higher CLIP scores and renal insufficiency, either preexisting before TACE or as a complication of TACE, are poor prognostic predictors in HCC patients receiving TACE.
肾功能不全常存在于肝硬化和肝细胞癌（HCC）患者中。由于造影剂，经动脉化疗栓塞（TACE）后可能会发生急性肾衰竭（ARF）。本研究调查了 TACE 治疗前存在肾功能不全的 HCC 患者发生 ARF 的发生率、危险因素和预后预测因子。
共纳入 566 例接受 TACE 的 HCC 患者。肾功能不全定义为估计肾小球滤过率（eGFR）<60mL/min/1.73m。
在平均 18+/-16 个月的随访中，231 例（40.8%）接受 TACE 的患者死亡。基线时存在肾功能不全的 134 例（23.7%）患者，在 Cox 比例风险模型中独立预测预后不良[风险比（RR）：1.47，P=0.012]。其中，13 例（10%）和 6 例（5%）患者在 TACE 后分别出现短暂性和持续性 ARF。多变量 logistic 回归分析显示，TACE 后胃肠道出血[比值比（OR）：16.54，P=0.001]和较高的肝癌意大利方案（CLIP）评分（>或=2；OR：4.22，P=0.02）是 ARF 的独立危险因素。在 Cox 模型中，持续性 ARF（RR：3.28，P<0.001）和较高的 CLIP 评分（>或=2；RR：2.13，P<0.001）是 TACE 治疗前存在肾功能不全的 HCC 患者的独立预后不良预测因子。
胃肠道出血和较高的 CLIP 评分与 HCC 合并肾功能不全患者 TACE 后 ARF 的发生相关。较高的 CLIP 评分和肾功能不全，无论是 TACE 前存在还是 TACE 后并发症，都是 TACE 治疗的 HCC 患者的不良预后预测因子。
