Predictors of Immediate Deterioration of the Child-Pugh Classification From A to B After Transcatheter Arterial Chemo-Embolization for Treatment-Naive Hepatocellular Carcinoma

IF 2.9 2区医学 Q2 ONCOLOGY Cancer Medicine Pub Date : 2024-11-02 DOI:10.1002/cam4.70367

Kazuo Asano, Ken Kageyama, Akira Yamamoto, Atsushi Jogo, Mariko Nakano, Kazuki Murai, Yoshimi Yukawa-Muto, Naoshi Odagiri, Kohei Kotani, Ritsuzo Kozuka, Etsushi Kawamura, Hideki Fujii, Sawako Uchida-Kobayashi, Masaru Enomoto, Norifumi Kawada, Yukio Miki

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Abstract

Aim

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).

Methods

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.

Results

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.

Conclusions

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.

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经导管动脉化疗栓塞治疗无效肝细胞癌后Child-Pugh分级从A级立即恶化为B级的预测因素

目的：本研究旨在评估未经治疗的肝细胞癌（HCC）患者经导管动脉化疗栓塞术（TACE）1个月后Child-Pugh分级恶化的预测因素：方法： 2010年至2020年期间，对接受了以表柔比星为初始治疗的传统TACE的连续患者进行了登记。纳入的患者均为巴塞罗那临床肝癌分期为0、A或B期且Child-Pugh分级为A级的患者。在治疗前和TACE后1个月对Child-Pugh评分进行评估。通过单变量和多变量分析，对以下变量进行了分析，以预测Child-Pugh分级从A级恶化到B级：年龄、性别、病因、血清白蛋白、胆红素、凝血酶原时间（PT）、脑病、腹水、最大肿瘤直径、肿瘤数量、肿瘤位置、α-胎儿蛋白、维生素K缺失或拮抗剂-II诱导的蛋白质、表柔比星用量、乙碘油用量和治疗肝段数量：结果：共有 152 名患者接受了回顾性治疗。Child-Pugh 分级从 A 到 B 的恶化率为 8.6%。多变量分析显示，血清白蛋白≤3.8 g/dL、PT≤80%和最大肿瘤直径≥3.8 cm是预测Child-Pugh分级恶化的因素。在只有一个上述因素的患者中，Child-Pugh B 级的恶化率为 0%，两个因素的恶化率为 14.3%，三个因素的恶化率为 70%：结论：血清白蛋白≤3.8 g/dL、PT≤80%和最大肿瘤直径≥3.8 cm可预测TACE后Child-Pugh分级从A级立即恶化为B级。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.