Department of Hepato-Bilio-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
Our aim was to investigate how transcatheter arterial chemoembolization (TACE) combined with percutaneous radiofrequency ablation (RFA) affected liver parenchymal function in patients with hepatocellular carcinoma (HCC), and to evaluate the significant risk factors for post-procedural deterioration of liver function.
Changes in liver laboratory tests and development of complications were monitored in 53 patients with unresectable hepatocellular carcinoma from January 2007 to January 2009. Cox proportional hazard regression model was performed to evaluate risk factors for deterioration of liver function after the procedure.
Plasma total bilirubin (TB) increased from pre-procedural 22.1 ± 12.4 μmol/L to 34.1 ± 21.8 μmol/L on post-procedural day three (P = 0.017). Alanine aminotransferase (ALT) also increased greatly from 65 ± 58 IU/L to 285 ± 182 IU/L post-procedurally (P = 0.006). Albumin (ALB) dropped from 42.5 ± 4.5 g/L to 34.6 ± 5.4 g/L (P = 0.019) and the Child-Pugh score increased from 5.2 ± 1.3 to 7.1 ± 1.5 three days after treatment (P = 0.021). Most of these parameters returned to normal range within 3-4 weeks. Thirty-three out of 53 patients developed complications in our study. Cox proportional hazards regression univariate analysis demonstrated that a Child-Pugh score ≥9 points and age ≥60 years were risk factors for deterioration of liver function after the procedure. Furthermore, a Child-Pugh score ≥9 points was found to be the only risk factor for post-procedural deterioration of liver function identified by stepwise multivariate analysis.
Liver function parameters such as plasma total bilirubin, ALT, serum ALB and Child-Pugh score could be transiently deteriorated by TACE combined with RFA in patients with Child-Pugh grades B or C. Therefore, patients with a Child-Pugh score ≥9 points were not appropriate candidates for TACE combined with RFA.