Impact Of The Different Intervals Between The First And Second Transarterial Chemoembolization On Liver Function In Patients With Unresectable Hepatocellular Carcinoma

OBJECTIVE To determine whether short and long intervals between two consecutive sessions of transcatheter arterial chemoembolization(TACE)generates different outcomes of liver function in patients with unresectable hepatocellular carcinoma(HCC)..METHOD A total of 90 patients with unresectable HCC who performed the first TACE and underwent at least two consecutive sessions of TACE without receiving other anti-tumor therapies in between from July 2013 to December 2018 were retrospectively analyzed.The patients were divided into groups A and B based on the median interval between the two sessions.Then,their pre-operative albumin(ALB),total bilirubin(TBIL),prothrombin time(PT),alanine aminotransferase(ALT),aspartate aminotransferase(AST),Child-Pugh(CP)scores and albumin-bilirubin(ALBI)grades were compared to data 6 days post-procedure and between the groups.RESULT The average interval between the first and second TACE was 48.2 ± 7.0 days(35 to 60 days)in group A and 75.5 ± 9.5 days(61 to 93 days)in group B.Significant differences were detected in ALB,TBIL,ALT,AST,CP scores,and ALBI grades in both groups at day 6 after the first and second TACE sessions comparing to pre-procedural data.ALB of group A was significantly decreased by 1.8 g/L before the second session comparing to that before the first session,and this number was significantly decreased by2.3 g/L when comparing to group B(P = 0.044,0.046,respectively).Of note,11.4% of patients in group A had ALBI grade drop from 1 to 2 before the second TACE,while the grade remained the same in group B.The difference between the two groups was statistically significant(P = 0.026).In addition,ALB was significantly decreased by 2.4 g/L in group A at day 6 after the second TACE comparing to that of group B(P = 0.033).At day6 after the second TACE,25.0% and 19.6% of patients experienced a decrease in ALBI grade from 1 to 2 in groups A and B,respectively,and the difference between the two groups was statistically significant(P = 0.001).CONCLUSION Transient liver damage was observed in both groups after each TACE session.Prolonged treatment interval is believed to help repair liver damage before the second TACE and to lower the risk of decreased liver function after the second TACE.