Post-transarterial Chemoembolization Liver Failure is Associated With Poor Outcome in Hepatocellular Carcinoma

Abstract

Background and Aim: Transarterial chemoembolization (TACE) is the recommended treatment of BCLC-A and B stages of hepatocellular carcinoma (HCC), when curative options are not feasible. Post-TACE decompensation is common. In this analysis of a prospectively acquired database, we aimed to determine the predictors of post-TACE liver failure (LF), and its effect on natural course of HCC. Methods: Consecutive HCC patients with Barcelona clinic liver cancer (BCLC) staging A/B were included between August 2012 and December 2015. Post-TACE LF was defined as occurrence of any of the following: new onset hepatic encephalopathy, increase in ascites, or increase in bilirubin > 0.9 mg/dl within 2 weeks of TACE. Survival in patients with and without post-TACE LF was compared with Kaplan-Meier graphs. Results: Of the total 111 patients; 102(91.9%) were males; median age was 56 years. A total of 139 sessions of TACE were performed—39 (28.1%) in BCLC class A and 100 (71.9%) in class B cases. Of the total 139 sessions of TACE, post-TACE LF developed in 31 (22.3%). On multivariate analysis, baseline serum bilirubin (P = 0.01), serum creatinine (P = 0.01), aspartate aminotransferase levels (P = 0.03) and serum alkaline phosphatase (P = 0.02) were associated with development of post-TACE LF. The 1- and 2-year survival in patients with and without post-TACE LF was 33.6% (16.2–51.9%) vs 69.3% (56.5–79.1%) and 24.0% (9.3–42.4%) vs 31.8% (16.3–48.5%), respectively (P = 0.001, log rank test). Conclusion: Post-TACE liver failure is common and is associated with poor outcome in patients with HCC. Better objective tests are required to predict its occurrence.