Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
J Gastroenterol. 2012 Oct;47(10):1134-42. doi: 10.1007/s00535-012-0577-0. Epub 2012 Mar 24.
Transcatheter arterial chemoembolization (TACE) is an effective treatment for hepatocellular carcinoma (HCC), but it sometimes makes liver function worse. The pre-TACE prediction of liver dysfunction after TACE would be helpful to avoid long-term liver dysfunction.
We performed a case-control study in 100 HCC patients who underwent TACE at Kobe University Hospital. Urinary/blood biochemical examinations were performed before TACE. As an indicator of liver function, Child's score was also evaluated before and 3 months after TACE. Cases with and without an increase of 2 points or more in the Child's score were compared, and independent risk factors were statistically examined. A pre-TACE predictive model of an increase of 2 points or more in the Child's score after TACE was developed using logistic regression.
Univariate analyses showed that des-γ-carboxy prothrombin (DCP) and lactate dehydrogenase (LDH) before TACE were significantly higher in the Child's score-deteriorated group than in the group with no deterioration (p = 0.036 and 0.003, respectively). All possible multivariate regressions showed that DCP (p = 0.003) and LDH (p = 0.002) were independent factors determining the deterioration of Child's class. A predictive model was developed, as follows: exp(0.014 × LDH + 0.572 × ln(DCP) - 8.655)/(1 + exp(0.014 × LDH + 0.572 × ln(DCP) - 8.655)). The model discriminated well, with AUC being 0.837 (95 % confidence interval [CI] 0.662-1.000). The optimal cut-off point was 0.073, and the sensitivity and specificity were 90.9 and 69.7 %, respectively.
High values of DCP and LDH before TACE were associated with the long-term deterioration of liver function. Our pre-therapeutic prediction model could be useful to identify high-risk cases.
经导管动脉化疗栓塞术（TACE）是治疗肝细胞癌（HCC）的有效方法，但有时会导致肝功能恶化。在 TACE 前预测 TACE 后肝功能障碍有助于避免长期肝功能障碍。
我们在神户大学医院进行了一项 100 例 HCC 患者的病例对照研究。在 TACE 前进行了尿/血生化检查。在 TACE 前后还评估了 Child 评分作为肝功能的指标。比较 Child 评分增加 2 分或更多的病例和没有增加的病例，并进行了统计学检验。使用逻辑回归建立了 TACE 后 Child 评分增加 2 分或更多的 TACE 前预测模型。
单因素分析显示，TACE 前 DCP 和 LDH 在 Child 评分恶化组中显著高于无恶化组（p=0.036 和 0.003）。所有可能的多变量回归均表明，DCP（p=0.003）和 LDH（p=0.002）是决定 Child 分级恶化的独立因素。建立了预测模型，如下所示：exp(0.014×LDH+0.572×ln(DCP)-8.655)/(1+exp(0.014×LDH+0.572×ln(DCP)-8.655))。该模型具有良好的判别能力，AUC 为 0.837（95%置信区间[CI]0.662-1.000）。最佳截断点为 0.073，灵敏度和特异性分别为 90.9%和 69.7%。
TACE 前 DCP 和 LDH 水平升高与肝功能长期恶化有关。我们的治疗前预测模型有助于识别高危病例。
