Influence Factors Of Hepatic Function Outcomes After Transcatheter Arterial Chemoembolization For Intermediate-advanced Primary Hepatocellular Carcinoma

BackgroundPrimary hepatocellular carcinoma is one of the most common malignancies in our country.It includes three categories in pathology,which are different in tumor markers and curative effects. At present, in case of unresectable hepatocellular (HCC), transcatheter arterial chemoembolization (TACE) is considered as a major palliative treatment by many authors. Although TACE is a useful palliative treatment in the world, there is damage on liver,even death. Some studies show that size,portal vein tumor thrombus,bilirubin,Child-pugh and so on are the prognostic factors. Some studies have shown that an acute and transient decrease in metabolic activity of the liver because of a transient ischemic effect on hepatic arterial circulation.But there are some differences among the results of patients. What is the factor?It may be good for patients to deal with the factor in time.The short-term impact of liver functor after TACE is unkown at present.Objective The purpose of our study was to evaluate the short term clinical impact of selective transarterial chemoembolization on liver function in patients with hepatocellular carcinoma.Materials and MethodsBetween December 2004 and November 2009,94 patients with HCC in Southern Hospital who were admitted. The sample size according to statistics that the sample size should be 16-21 times more than the number of variable.Inclusion criteria:â… . Between December 2004 and November 2009, patients with HCC had have at least two TACE in Southern Hospital.â…¡. The diagnosis of HCC was according to diagnostic criteria of primary hepatic carcinoma of Chinese Society of Liver Cancer in 1999.â…¢. Intermediate-advanced stage was according to the BCLC classification.Exclusion criteria:â… . the patients who were given only once TACE treatment.â…¡. the patients with cholangiocellular carcinoma by pathology.â…¢. the patients whose test datas were missing.Records project: age,sex,tumor size,tumor number,KPS score, Hepatic encephalopathy or not before TACE treatment,ascites,prothrombin time(PT),FQ-HBV,liver function tests,portal vein tumor thrombus or not. AFP,AST,ALT,TBIL,DBIL,albumin are tested in a week before and 4 to 10 days after TACE treatment.Procedure: A small amount of antitumor agents was used in combination with TACE:10mg to 20 mg of pirarubicin and 5mg to 10 mg Hydroxycamptothecin For Injection and 50mg to 200mg Oxaliplatin Injection and 10 mg mitomycin. Some patients were given gelatin sponge particle or PVA microparticle. After TACE, antacids and analgesics were given if necessary. We performed statistical analysis on the following variables:Child-pugh class, AFP 1,tumor size.portal vein tumor thrombus,volume of lipiodol,serum total bilirubin level,embolism with particle or not,arteriovenous fistula(AVF),FQ-HBV,times of TACE treatment, aspartate aminotransferase (AST),alanine transarninase(ALT),serum total bilirubin level(TBIL), direct reacting bilirubin(DBIL),serum total bilirubin level.evaluation of liver function:AST,ALT,TBIL,DBIL,albumin.Statistics Methods:two sample t test, multivariate analysis,Logistic stepwise regression analysis.statistical software:SPSS13.0. a=0.05ResultsBetween December 2004 and November 2009,94 patients were admitted and repeated the TACE treatment 2 to 8 times. Patients' ages ranged from 12 to 75 years(median,51 years). KPS score was between 70 and 100.One hundred and forty-four patients had single tumor nodules, twenty-eight patients had two tumors nodules, and eighty-two patients had three or more than three. Size of the tumor smaller than 5 cm was found in 48 cases, bigger than 5 cm was 204 cases. Portal vein invasion detected by ultrasonogram, computed tomography, or angiogram was found in 91 cases.The TBIL value of three patients were more than 51.3umol/L.ALT,TBIL,DBIL were slightly elevated and albumin was slightly lower(P<0.01). TBIL 2 of patients with portal vein tumor thrombus was significantly elevated compared that without portal vein tumor thrombus.Albumin of patients with Child-pugh A was significantly lower after TACE treatment compared that with Child-pugh B.(P=0.001)ALT and albumin of patients with particles embolization were significantly different from that with without particles embolization. ALT and albumin of patients who were given lipiodol more than 12 ml were significantly different from that with less than 12 ml.ALT 1 and AST 2 of patients with FQ-HBV was more than 104 copies/m were significantly higher than that with less than 104 copies/m.ALT 2 and AST 2 of patients with FQ-HBV was more than 104 copies/m were significantly different than that with less than 104 copies/m.When the value of ALT 1,AST 1,TBIL 1 were high, the range of the value of ALT 2,AST 2,TBIL 2 were small.The multivariate analysis:portal vein tumor thrombus or not was the factor of TBIL difference and DBIL difference (P<0.05).Child-pugh score and embolization with particle or not were the factor of albumin difference (P<0.01).Logistic stepwise regression analysis:the valume of lipiodol and FQ-HBV was the dangerous factors of TBIL.ConclusionsThere might be some damage on liver function after TACE. The portal vein tumor thrombus,particles embolization and the volume of lipiodol might aggravate liver function. Portal vein tumor thrombus,FQ-HBV,the volume of lipiodol were the risk factors to raise the TBIL.