Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan.
Cancer Med. 2024 Nov;13(21):e70367. doi: 10.1002/cam4.70367.
The purpose of this study was to evaluate the predictors of deterioration of the Child-Pugh classification 1 month after transcatheter arterial chemo-embolization (TACE) in patients with treatment-naive hepatocellular carcinoma (HCC).
Between 2010 and 2020, consecutive patients who underwent conventional TACE using epirubicin as the initial treatment were enrolled. Patients with Barcelona Clinic Liver Cancer stage-0, A or B and Child-Pugh class A were included. The Child-Pugh score was evaluated before treatment and 1 month after TACE. The following variables were analyzed by univariate and multivariate analyses as predictors of deterioration of the Child-Pugh class from A to B: age, sex, etiology, serum albumin, bilirubin, prothrombin time (PT), encephalopathy, ascites, largest tumor diameter, tumor number, tumor location, α-fetoprotein, protein induced by vitamin K absence or antagonist-II, epirubicin dosage, ethiodized oil dosage, and number of treated liver segments.
A total of 152 patients were retrospectively enrolled. The deterioration rate of the Child-Pugh class from A to B was 8.6%. Multivariable analysis showed that serum albumin ≤ 3.8 g/dL, PT ≤ 80%, and largest tumor diameter ≥ 3.8 cm were predictors of deterioration of the Child-Pugh class. The deterioration rate to Child-Pugh class B was 0% in patients with up to one of these factors, 14.3% in those with two factors, and 70% in those with three factors.
A combination of serum albumin ≤ 3.8 g/dL, PT ≤ 80%, and largest tumor diameter ≥ 3.8 cm can predict the immediate deterioration of the Child-Pugh classification from A to B following TACE.
本研究旨在评估经导管动脉化疗栓塞（TACE）治疗初治肝细胞癌（HCC）患者 Child-Pugh 分级 1 个月后恶化的预测因素。
2010 年至 2020 年期间，连续纳入接受表阿霉素作为初始治疗的常规 TACE 治疗的患者。纳入巴塞罗那临床肝癌分期 0 期、A 期或 B 期和 Child-Pugh 分级 A 级的患者。在治疗前和 TACE 后 1 个月评估 Child-Pugh 评分。通过单因素和多因素分析，分析以下变量作为 Child-Pugh 分级从 A 级恶化至 B 级的预测因素：年龄、性别、病因、血清白蛋白、胆红素、凝血酶原时间（PT）、肝性脑病、腹水、最大肿瘤直径、肿瘤数量、肿瘤位置、甲胎蛋白、维生素 K 拮抗剂诱导蛋白-II、表阿霉素剂量、碘油剂量和治疗肝段数。
共回顾性纳入 152 例患者。Child-Pugh 分级从 A 级恶化至 B 级的恶化率为 8.6%。多因素分析显示，血清白蛋白≤3.8g/dL、PT≤80%和最大肿瘤直径≥3.8cm 是 Child-Pugh 分级恶化的预测因素。在这些因素中，有一个因素的患者 Child-Pugh 分级恶化率为 0%，有两个因素的患者 Child-Pugh 分级恶化率为 14.3%，有三个因素的患者 Child-Pugh 分级恶化率为 70%。
血清白蛋白≤3.8g/dL、PT≤80%和最大肿瘤直径≥3.8cm 的组合可以预测 TACE 后 Child-Pugh 分级从 A 级立即恶化至 B 级。
