Zhao Jieqiong, Zou Zhihui, Zheng Qin, Liu Caifeng
Department of Outpatient, Eastern Hepatobiliary Surgery Hospital, Naval Military Medical University Shanghai 201805, China.
Department of Hepatobiliary Surgery VI, Eastern Hepatobiliary Surgery Hospital, Naval Military Medical University Shanghai 201805, China.
Am J Cancer Res. 2025 May 15;15(5):2259-2274. doi: 10.62347/PJVG6340. eCollection 2025.
To identify clinical predictors of liver function impairment and post-embolization syndrome (PES) following transcatheter arterial chemoembolization (TACE) in patients with primary hepatic carcinoma (PHC), to facilitate risk stratification and improve clinical outcomes.
A retrospective study was conducted on 549 PHC patients who underwent TACE at Eastern Hepatobiliary Surgery Hospital, Naval Military Medical University from June 2020 to January 2024. Data on demographics, liver function, imaging findings, and TACE regimens were collected. Multivariate Logistic regression analysis was employed to identify the independent risk factors for liver function impairment and PES. The predictive performance of these factors was evaluated using receiver operating characteristic (ROC) curve analysis.
Among the 549 PHC, 61.93% (340/549) developed liver function impairment and 26.96% (148/549) experienced PES after TACE. ROC analysis indicated that alcohol consumption, cirrhosis, liver function grade, and TACE frequency demonstrated predicted value for liver impairment (AUCs: 0.565-0.619) and PES (AUCs: 0.581-0.656). Multivariate logistic regression identified neutrophils (OR=2.349, P=0.001), prealbumin (PA) (OR=1.674, P=0.028), liver function grade (OR=3.135, P<0.001), alcohol consumption (OR=0.296, P<0.001), cirrhosis (OR=0.528, P=0.005), and TACE frequency (OR=0.482, P=0.001) as independent predictors for liver impairment; For PES, alcohol consumption (OR=1.959, P=0.003), body mass index (BMI) (OR=0.288, P<0.001), albumin (ALB) (OR=0.384, P=0.005), PA (OR=0.288, P<0.001), and ECOG score (OR=0.527, P=0.006) were identified as the independent predictors, whereas liver function grade (P=0.287) and TACE frequency (P=0.634) were not. Nomograms based on these predictors demonstrated good discriminative ability (AUC=0.854 for liver impairment; AUC=0.826 for PES) and satisfactory calibration (P>0.05), with consistent performance in both training and validation cohorts (AUC: 0.852-0.854 for liver impairment; 0.820-0.843 for PES).
Key clinical variables, including alcohol consumption, cirrhosis, and specific biochemical markers, are significantly associated with liver function impairment and PES following TACE in PHC patients. These findings support the development of individualized treatment strategies to improve patient outcomes.
确定原发性肝癌（PHC）患者经导管动脉化疗栓塞术（TACE）后肝功能损害和栓塞后综合征（PES）的临床预测因素，以促进风险分层并改善临床结局。
对2020年6月至2024年1月在海军军医大学东方肝胆外科医院接受TACE治疗的549例PHC患者进行回顾性研究。收集人口统计学、肝功能、影像学检查结果和TACE治疗方案的数据。采用多因素Logistic回归分析确定肝功能损害和PES的独立危险因素。使用受试者工作特征（ROC）曲线分析评估这些因素的预测性能。
在549例PHC患者中，61.93%（340/549）发生肝功能损害，26.96%（148/549）在TACE后出现PES。ROC分析表明，饮酒、肝硬化、肝功能分级和TACE频率对肝功能损害（AUC：0.565 - 0.619）和PES（AUC：0.581 - 0.656）具有预测价值。多因素Logistic回归确定中性粒细胞（OR = 2.349，P = 0.001）、前白蛋白（PA）（OR = 1.674，P = 0.028）、肝功能分级（OR = 3.135，P < 0.001）、饮酒（OR = 0.296，P < 0.001）、肝硬化（OR = 0.528，P = 0.005）和TACE频率（OR = 0.482，P = 0.001）为肝功能损害的独立预测因素；对于PES，饮酒（OR = 1.959，P = 0.003）、体重指数（BMI）（OR = 0.288，P < 0.001）、白蛋白（ALB）（OR = 0.384，P = 0.005）、PA（OR = 0.288，P < 0.001）和美国东部肿瘤协作组（ECOG）评分（OR = 0.527，P = 0.006）被确定为独立预测因素，而肝功能分级（P = 0.287）和TACE频率（P = 0.634）则不是。基于这些预测因素的列线图显示出良好的判别能力（肝功能损害的AUC = 0.854；PES的AUC = 0.826）和令人满意的校准（P > 0.05），在训练和验证队列中表现一致（肝功能损害的AUC：0.852 - 0.854；PES的AUC：0.820 - 0.843）。
关键临床变量，包括饮酒、肝硬化和特定生化标志物，与PHC患者TACE后的肝功能损害和PES显著相关。这些发现支持制定个体化治疗策略以改善患者结局。
