Department of Hematology and Oncology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Department of Gastroenterology, Chiba University, Chiba, Japan.
BMC Cancer. 2019 Aug 13;19(1):795. doi: 10.1186/s12885-019-5989-2.
The real-world incidence of chronic liver damage after transarterial chemoembolization (TACE) is unclear. LiverT, a retrospective, observational study, assessed liver function deterioration after a single TACE in real-world hepatocellular carcinoma (HCC) patients in US practice.
Eligible HCC patients identified from Optum's integrated database using standard codes as having had an index TACE between 2010 and 2016 with no additional oncologic therapy in the subsequent 3 months. At least one laboratory value (bilirubin, albumin, aspartate transaminase [AST], alanine transaminase [ALT], international normalized ratio [INR]) was required at baseline and the acute (≤29 days after TACE) and chronic (30-90 days after TACE) periods. Due to lack of universally accepted liver function deterioration criteria, clinically meaningful changes in laboratory parameters were pre-defined by authors (FP, RM, and SO).
Of the 3963 TACE patients, 572 were eligible for analyses. Deterioration of liver function from baseline occurred in the acute period and persisted in the chronic period (bilirubin 30 and 23%, albumin 52 and 31%, AST 44 and 25%, ALT 43 and 25%, INR 25 and 15%, respectively). In a subgroup analysis, a higher proportion of patients with diabetes had deterioration in AST and ALT.
A clinically meaningful proportion of real-world HCC patients had deterioration of liver function-related laboratory values 30-90 days after a single TACE in modern US practice. Future electronic health record research may help determine causality. The present findings highlight the need for the careful selection of patients for TACE, which is important to help optimize the benefit of the overall HCC treatment course.
经动脉化疗栓塞术（TACE）后慢性肝损伤的真实世界发生率尚不清楚。LiverT 是一项回顾性、观察性研究，评估了美国真实世界中肝细胞癌（HCC）患者单次 TACE 后肝功能恶化的情况。
使用标准代码从 Optum 的综合数据库中确定符合条件的 HCC 患者，这些患者在 2010 年至 2016 年间接受了指数 TACE，并且在随后的 3 个月内没有接受额外的肿瘤治疗。在基线时至少需要有一个实验室值（胆红素、白蛋白、天冬氨酸转氨酶 [AST]、丙氨酸转氨酶 [ALT]、国际标准化比值 [INR]），并且在急性（TACE 后≤29 天）和慢性（TACE 后 30-90 天）期间需要有实验室值。由于缺乏普遍接受的肝功能恶化标准，作者预先定义了实验室参数的临床显著变化（FP、RM 和 SO）。
在 3963 名 TACE 患者中，有 572 名符合分析条件。从基线开始，肝功能在急性期间恶化，并在慢性期间持续恶化（胆红素分别为 30%和 23%，白蛋白分别为 52%和 31%，AST 分别为 44%和 25%，ALT 分别为 43%和 25%，INR 分别为 25%和 15%）。在亚组分析中，患有糖尿病的患者 AST 和 ALT 恶化的比例更高。
在现代美国实践中，相当一部分真实世界的 HCC 患者在单次 TACE 后 30-90 天内出现与肝功能相关的实验室值恶化。未来的电子健康记录研究可能有助于确定因果关系。目前的研究结果强调了为 TACE 仔细选择患者的必要性，这对于帮助优化整个 HCC 治疗过程的获益非常重要。
