Identification of predictive factors for post-transarterial chemoembolization liver failure in hepatocellular carcinoma patients: A retrospective study

Table 1 Baseline characteristics and laboratory parameters of hepatocellular carcinoma patients received post-transarterial chemoembolization

Variables	Total (n = 199)	None post-TACE liver failure (n = 129)	Post-TACE liver failure (n = 70)	P value
Age, yr, mean ± SD	59.4 ± 10.9	59.7 ± 11.1	58.9 ± 10.7	0.59
Male, n (%)	157 (78.9)	105 (81.4)	52 (74.3)	0.24
Metastasis, n (%)
Renal/adrenal	5 (2.5)	5 (3.9)	0 (0)	0.095
Abdomen/pelvis	6 (3.0)	4 (3.1)	2 (2.9)	0.92
Lymphnode	5 (2.5)	3 (2.3)	2 (2.9)	0.82
Bone	8 (4.0)	7 (5.4)	1 (1.4)	0.17
Lung	10 (5.0)	5 (3.9)	5 (7.1)	0.31
Intrahepatic	11 (5.5)	5 (3.9)	6 (8.6)	0.17
Pleural effusion, n (%)	21 (10.6)	15 (11.6)	6 (8.6)	0.50
Ascites, n (%)	59 (29.6)	38 (29.5)	21 (30.0)	0.94
PVTT, n (%)	56 (28.1)	33 (25.6)	23 (32.9)	0.28
Vascular invasion, n (%)	16 (8.0)	13 (10.1)	3 (4.3)	0.15
Tumor number, n (%)				0.81
1	71 (37.8)	44 (36.1)	27 (40.9)
2	27 (14.4)	18 (14.8)	9 (13.6)
≥ 3	90 (47.9)	60 (49.2)	30 (45.5)
Times of TACE prior to inclusion, median (IQR)	1 (0, 3)	1 (0, 2)	1 (0, 3)	0.82
Embolization, n (%)
Microspheres	55 (27.6)	33 (25.6)	22 (31.4)	0.378
Gelatin	20 (10.1)	12 (9.3)	8 (11.4)	0.634
Microspheres plus gelatin	22 (11.1)	5 (3.9)	17 (24.3)	< 0.001
Lipiodol, mL, median (IQR)	10 (5, 10)	8 (5, 10)	10 (6, 10)	0.17
Pirarubicin, mg, n (%)				0.68
0	55 (27.6)	37 (28.7)	18 (25.7)
10	36 (18.1)	25 (19.4)	11 (15.7)
20	99 (49.7)	63 (48.8)	36 (51.4)
30	4 (2.0)	2 (1.6)	2 (2.9)
40	4 (2.0)	2 (1.6)	2 (2.9)
50	1 (0.5)	0 (0)	1 (1.4)
Lobaplatin, mg, n (%)				0.46
0	45 (22.6)	28 (21.7)	17 (24.3)
25	1 (0.5)	1 (0.8)	0 (0)
50	152 (76.4)	100 (77.5)	52 (74.3)
200	1 (0.5)	0 (0)	1 (1.4)
Combination with RFA, n (%)	22 (11.1)	19 (14.7)	3 (4.3)	0.025
Main tumor size ≥ 5cm, n (%)	93 (46.7)	52 (40.3)	41 (58.6)	0.014
CNLC, n (%)				0.071
I	93 (46.7)	66 (51.2)	27 (38.6)
II	50 (25.1)	26 (20.2)	24 (34.3)
III	39 (19.6)	28 (21.7)	11 (15.7)
NA	17 (8.5)	9 (7.0)	8 (11.4)
Cirrhosis, n (%)	185 (93.0)	121 (93.8)	64 (91.4)	0.53
CTP score, median (IQR)	5 (5, 6)	5 (5, 6)	6 (5, 6)	0.438
MELD score, median (IQR)	29.6 (27.3, 32.2)	29.7 (27.4, 32.3)	29.5 (27.1, 32.0)	0.463
Treatment history, n (%)
Sorafenib	21 (10.6)	14 (10.9)	7 (10.0)	0.85
Resection	49 (24.6)	38 (29.5)	11 (15.7)	0.032
Radiology	72 (36.2)	45 (34.9)	27 (38.6)	0.61
Hypertension, n (%)	43 (21.6)	27 (20.9)	16 (22.9)	0.75
Diabetes, n (%)	29 (14.6)	23 (17.8)	6 (8.6)	0.077
Blood routine tests, median (IQR)
WBC, 103/mm3	4.7 (3.5, 6.0)	4.6 (3.4, 6.1)	5.0 (3.8, 5.9)	0.41
RBC, 104/mm3	4.1 (3.6, 4.6)	4.1 (3.6, 4.5)	4.3 (3.7, 4.6)	0.13
Hemoglobin, g/L	127 (112, 141)	124 (109, 140.5)	132.5 (116, 144)	0.069
Hematocrit, %	37.0 (6.3)	36.3 (6.6)	38.3 (5.7)	0.032
PLT, 103/mm3	123.5 (80, 163)	127 (82.5, 167)	115 (75, 160)	0.42
Neutrophils, 103/mm3	2.9 (2.0, 3.9)	2.9 (1.9, 3.8)	2.9 (2.0, 3.9)	0.53
Lymphocytes, 103/mm3	1.1 (0.8, 1.4)	1.1 (0.7, 1.4)	1.1 (0.8, 1.4)	0.44
Monocytes, 103/mm3	0.4 (0.3, 0.6)	0.4 (0.3, 0.5)	0.4 (0.3, 0.6)	0.61
Hypersensitive CRP, mg/L	3.0 (0.7, 23.5)	3.6 (0.7, 23.5)	2.6 (0.6, 23.7)	0.77
Liver functions, median (IQR)
ALT, U/L	29 (20, 44)	26 (19, 38)	37 (25, 54)	0.002
AST, U/L	38 (26, 61)	32 (25, 53)	45.5 (32, 69)	< 0.001
GGT, U/L	78 (41, 175)	63 (40, 156)	115 (54, 210)	0.057
AKP, U/L	137 (97, 197)	129 (94, 192)	154.5 (115, 207)	0.068
TBiL, μmol/L	19 (13.1, 28.7)	17.3 (12.2, 25.2)	21.9 (15.6, 30.9)	0.010
DBiL, μmol/L	8.5 (5.9, 12.7)	7.9 (5.4, 11.5)	9.9 (6.5, 15.6)	0.007
TBA, μmol/L	17.7 (8.2, 40.5)	15 (7.8, 32.8)	22.1 (8.5, 44.9)	0.091
Albumin, g/L	37.8 (33.7, 42.1)	37.7 (33.7, 42.2)	38.2 (34.4, 41.7)	0.93
Cholinesterase, U/L	5224 (3698, 6826)	5056 (3745, 6814)	5297.5 (3493, 6917)	0.73
Kidney functions, median (IQR)
Serum cystatin C, mg/L	0.97 (0.8, 1.13)	0.99 (0.8, 1.19)	0.89 (0.77, 1.04)	0.021
Urea, mmol/L	4.8 (4.0, 5.9)	5.0 (4.0, 6.17)	4.47 (4, 5.7)	0.28
Creatinine, μmol/L	62.4 (52.7, 74.5)	64.5 (54.0, 81.2)	59.7 (51, 68)	0.025
eGFR, mL/(min∙1.73 m2)	116.1 (93.6, 137.9)	111.6 (87.8, 135.7)	127 (104.8, 140.3)	0.039
Serum ammonia, median (IQR)	45 (34, 60)	43.5 (34, 57)	48 (35, 62)	0.27
Coagulation function tests, median (IQR)
PTA, %	84 (73.5, 93)	83 (73, 92)	86 (74, 95)	0.34
Prothrombin time, s	14.4 (13.8, 15.5)	14.5 (13.8, 15.5)	14.3 (13.5, 15.4)	0.40
INR	1.11 (1.04, 1.22)	1.12 (1.05, 1.22)	1.1 (1.03, 1.21)	0.31
APTT, s	39.3 (36.4, 42.1)	38.9 (36.7, 42)	39.4 (36.3, 42.9)	1.00
TT, s	17.7 (17, 18.7)	17.6 (16.9, 18.6)	17.7 (17.2, 18.8)	0.34
Fibrinogen, g/L	2.9 (2.4, 3.7)	2.9 (2.4, 3.7)	3.0 (2.4, 3.7)	0.99
Serum tumor markers, median (IQR)
CA125, U/L	21.8 (12.3, 59.1)	21.8 (12.3, 62.8)	22.3 (12.9, 54.3)	0.86
CA153, U/L	12.9 (9.7, 18.6)	12.4 (9.0, 18.5)	13.7 (10.7, 18.7)	0.40
CA199, U/L	19 (10.8, 38.5)	18.5 (10.7, 34.6)	21.1 (12.5, 41.4)	0.42
AFP, ng/mL	26.8 (5.2, 745.1)	20.3 (5.3, 639.1)	58.2 (5, 1210)	0.46
CEA, ng/mL	2.7 (1.9, 4.2)	3.1 (2.0, 5.1)	2.5 (1.8, 3.8)	0.082

TACE: Post-transarterial chemoembolization; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; CNLC: China Liver Cancer Staging; CRP: C-reactive protein; CTP: Child-Turcotte-Pugh; DBiL: Direct bilirubin; eGFR: Estimated glomerular filtration rate; ESR: Erythrocyte sedimentation rate; GGT: Gamma-glutamyl transferase; INR: International normalized ratio; LDH: Lactate dehydrogenase; MELD: Mode for End-stage Liver Disease; PTA: Prothrombin activity; PVTT: Portal vein tumor thrombus; RBC: Red blood cells; RFA: Radiofrequency ablation; TBA: Total bile acid; TBiL: Total bilirubin; WBC: White blood cells; IQR: Interquartile range; NA: Not available.

Table 2 Univariate and multivariate logistic models for identifying risk factors of post-transarterial chemoembolization liver failure¹

Variables	Univariate		P value	Multivariate		P value
	OR	95%CI		OR	95%CI
Microsphere plus gelatin embolization, yes vs no	8.0	2.8-22.7	< 0.001	4.4	1.2-16.3	0.027
Combination with RFA, yes vs no	0.3	0.1-0.9	0.035	0.3	0.1-1.2	0.094
Main tumor size ≥ 5 cm, yes vs no	2.1	1.2-3.8	0.014	2.3	1.05-5.3	0.039
Resection history, yes vs no	0.4	0.2-0.9	0.034	0.4	0.2-0.95	0.039
Diabetes, yes vs no	0.4	0.2-1.1	0.084	0.3	0.1-1.03	0.056
Hematocrit, per increase 1%	1.1	1.0-1.1	0.034	1.1	0.997-1.1	0.06
ALT, per increase 1 U/L	1.01	1.0-1.03	0.026	1.01	0.99-1.03	0.262
AST, per increase 1 U/L	1.0	1.0-1.01	0.074	0.99	0.98-1.004	0.177
GGT, per increase 1 U/L	1.0	1.0-1.0	0.08	1.0	1.0-1.0	0.499
TBiL, μmol/L
Normal	Reference	-	1.0	Reference	-	1.0
1-2 ULN	1.8	1.0-3.5	0.065	1.8	0.8-4.2	0.163
≥ 2 ULN	2.3	1.0-5.3	0.062	2.1	0.6-7.5	0.269
DBiL, per increase 1 μmol/L	1.8	1.0-3.2	0.054	0.99	0.96-1.02	0.718
TBA ≥ 17.7μmol/L, yes vs no	1.8	1.0-3.3	0.044	1.6	0.7-3.5	0.263
Serum cystatin C, per increase 1 mg/L	0.4	0.1-1.0	0.041	0.6	0.1-3.6	0.584
Creatinine, per increase 1 μmol/L	0.98	0.97-1.0	0.048	0.99	0.95-1.02	0.499
eGFR, per increase 1 ml/(min∙1.73 m2)	1.01	1.0-1.02	0.033	1.0	0.98-1.02	0.81

¹Only variables significantly associated with post-transarterial chemoembolization liver failure in univariate analysis (P < 0.10) were presented.

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; direct bilirubin; eGFR: Estimated glomerular filtration rate; GGT: Gamma-glutamyl transferase; RFA: Radiofrequency ablation; TBA: Total bile acid; TBiL: Total bilirubin; ULN: Upper limit of normal; OR: Odds ratio; CI: Confidence interval.