Predictive Factors for Hepatic Decompensation after Transarterial Chemoembolization for Hepatocellular Carcinoma

Abstract Background Hepatocellular carcinoma (HCC) is one of the most common cancers worldwide, and has a poor prognosis unless treated. Transarterial chemoembolization (TACE) of HCC lesions is a promising treatment option for patients who are not eligible for surgery. There are various risk factors that can contribute to the development of hepatic decompensation such as liver function status, HCC morphology and patient’s comorbidities. Aim of the Work to analyse the different predictive parameters for hepatic decompensation after transarterial chemoembolisation (TACE) for hepatocellular carcinoma (HCC). Patients and Methods Our study included 50 patients who underwent TACE for HCC, mostly males (72%) with HCV being the most common cause (86%) of HCC in our sample. Results The results showed that 44% of patients developed hepatic decompensation after TACE. Comparison was done between the compensated and decompensated patients as regards different epidemiologic, laboratory and tumor morphology variables. Regarding the pre-TACE laboratory data, the decompensated group had significantly lower levels of albumin and higher levels of bilirubin, ALT, AST and INR. There was no statistically significant difference in the levels of AFP and creatinine between the two groups. Regarding the tumor characteristics in our study groups, the size and number of nodules were significantly higher in the decompensated group. However, the location and the distribution of the tumor between the two groups were not statistically significant. Multivariate analysis revealed that serum bilirubin level (p = 0.007 at 95% CI), MELD score (p value=0.011 at 95% CI) and ALBI score (p = 0.021 at 95% CI) were the statistically significant independent factors predictive of decompensation after TACE. Conclusion There is significant hepatic decompensation after TACE for patients with HCC. Serum bilirubin level with the ALBI and MELD scores were the independent predictors of decompensation after TACE. Patients should be cautiously selected for TACE and prioritized in post-operative management to early identify the signs of hepatic decompensation. This would allow prioritized treatment and improve the chances of survival.