Hepatic decompensation after transarterial radioembolization (TARE) – a retrospective analysis of risk factors and outcome of patients with HCC

Introduction Hepatic decompensation (HD) is a severe complication after TARE, associated with significant morbidity and mortality. The aim of this study was to identify prognostic factors of HD and outcome after TARE in patients with HCC.

Methods 61 HCC-patients treated with TARE were retrospectively included. HD was defined as an increase of bilirubin (minimum CTCAE grade 3) or newly developed ascites not explained by tumor progression 3 months after TARE. Logistic-regression-models were performed to analyze predictive factors of HD. Survival was assessed by Kaplan-Meier-estimator and multivariable Cox-regression-models were performed for analysis of prognostic factors.

Results 17 patients developed HD during follow-up. Patients with HD presented with higher ALBI-score (-2.1 [-1.7;-2.5] vs. -2.7 [-2.3;-3.1], p < 0.001) and CRP (16.9 mg/l [7.1;35.0] vs. 6.0 mg/l [3.8;12.1], p=0.007) pre-treatment compared to patients without decompensation. ALBI-grade (2 vs. 1; OR 20.13 [3.21;125.9], p=0.001) and higher Yttrium-90-activity (OR 4.60 [1.13;18.74], p=0.033) were independent risk factors for the development of HD. The median survival of patients with HD was significantly reduced (3±0.94 vs. 13±6.6 months, p < 0.001). HD significantly increased the mortality-risk, adjusted for age, liver cirrhosis, portal vein thrombosis, number of HCC-lesions, Yttrium-90-activity, and creatinine (HR 3.22 (1.49;6.93), p=0.003).

Conclusion HD after TARE leads to a 3-fold increase of mortality in HCC-patients. Thus, prevention of HD is crucial in improving outcome of these patients. Current guidelines recommend TARE for patients with bilirubin-levels < 2 mg/dl. We suggest rather assessing liver function by ALBI-score as a valid predictor of HD in patients with HCC.

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Artikel online veröffentlicht:
26. Januar 2022