title: Predictors of hepatic decompensation after TACE for hepatocellular carcinoma.
abstract: OBJECTIVE
  To study predictive factors for hepatic decompensation after transarterial chemoembolisation (TACE) for hepatocellular carcinoma (HCC).
  
  
  METHODS
  Between November 2009 and August 2010, of 254 patients with HCC who presented to our multidisciplinary HCC clinic for evaluation, 102 (40%) were amenable for TACE. In this prospective study, there were 102 patients with compensated cirrhosis with HCC and Child-Pugh Class A cirrhosis who underwent TACE at the National Liver Institute, Menoufiya University, Egypt. We excluded all patients with prior locoregional therapy, systemic therapy and/or surgical intervention. At baseline and at 1 month postprocedure, laboratory criteria, tumour criteria (size, number) and Child-Pugh score were recorded. Patients were classified into group 1 (no Child-Pugh point increase after TACE) and group 2 (one or more added Child-Pugh points after TACE, defining hepatic decompensation). Univariate and multivariate analyses were performed to identify factors predictive of hepatic decompensation.
  
  
  RESULTS
  Patients were mostly males (82.4%) of mean age 58.4±8.1 years. The only significant changes in laboratory findings at 1 month after TACE were increased international normalised ratio, serum total bilirubin, alanine transaminase and aspartate transaminase and decreased serum albumin and α-fetoprotein (AFP). The statistically significant predictive factors for hepatic decompensation using univariate analysis were found to be baseline lower serum albumin, higher serum α-fetoprotein, more advanced Barcelona Clinic Liver Cancer (BCLC) stage, larger tumour size and a greater number of tumour nodules; with logistic regression, multivariate analysis found that at baseline larger tumour size (p=0.004 at 95% CI), higher serum AFP (p=0.046 at 95% CI) and lower serum albumin (p=0.033 at 95% CI) predicted decompensation; BCLC stage, number of tumour nodules and pre-TACE bilirubin did not predict changes in liver function.
  
  
  CONCLUSIONS
  Lower serum albumin and increased tumour burden (larger tumour size/more nodules and higher α-fetoprotein) at baseline may help predict post-TACE decompensation.
authors.affiliation: Department of Hepatology , National Liver Institute, Menoufiya University , Shebeen El-Kom, Menoufiya , Egypt.
authors.forename: Mohamed A S
authors.initials: MA
authors.lastname: Kohla
authors.affiliation: Department of Hepatology , National Liver Institute, Menoufiya University , Shebeen El-Kom, Menoufiya , Egypt.
authors.forename: Mai I
authors.initials: MI
authors.lastname: Abu Zeid
authors.affiliation: Department of Radiology , National Liver Institute, Menoufiya University , Shebeen El-Kom, Menoufiya , Egypt.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Al-Warraky
authors.affiliation: Department of Hepatology , National Liver Institute, Menoufiya University , Shebeen El-Kom, Menoufiya , Egypt.
authors.forename: Hossam
authors.initials: H
authors.lastname: Taha
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology , Stanford University , Stanford, California , USA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Gish
keywords: HEPATOCELLULAR CARCINOMA; LIVER; LIVER FAILURE