Abstract
Transarterial chemoembolization (TACE) is the recommended first-line treatment for intermediate-stage hepatocellular carcinoma (HCC). In patients who became refractory to TACE, a treatment switch to tyrosine kinase inhibitors (TKIs) needs to be considered. However, TACE could worsen liver function, thereby narrowing the time window for a switch to TKIs because TKIs are recommended for patients with Child-Pugh grade A (CP-A). We investigated the factors associated with CP grade deterioration after TACE. Among patients who underwent TACE, 125 patients with CP-A were enrolled. The cumulative CP grade deterioration rates were 20.3%, 27.1%, and 41.4% at six months, one year, and two years, respectively. Multivariate analysis revealed that factors associated with CP grade deterioration included high Mac-2 binding protein glycosylation isomer (M2BPGi) levels (>2.00 cut-off index) and beyond the up-to-seven criteria. The cumulative CP grade deterioration rates of patients with high M2BPGi and beyond the up-to-seven criteria were 50.6% and 59.2% at six months and one year, respectively, which were significantly higher than for those in any other groups. The combination of M2BPGi and up-to-seven criteria could be a surrogate marker for predicting CP grade deterioration after TACE. In patients with intermediate-stage HCC, elevated M2BPGi levels, and beyond the up-to-seven criteria, an early treatment switch to TKIs should be considered to improve their prognosis.
Highlights
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second most frequent cause of cancer-related deaths and has been estimated to be responsible for approximately 810,000 deaths per year worldwide [1]
We suggest that the combination of Mac-2 binding protein glycosylation isomer (M2BPGi) and up-to-seven criteria could be a promising surrogate marker for early CP grade deterioration from A to B after transarterial chemoembolization (TACE) for patients with HCC
In cases with deteriorated liver function after repeated TACE, tyrosine kinase inhibitors (TKIs) were not recommended because the efficacy and safety of TKIs for patients with CP grade B (CP-B) was not guaranteed by clinical trials [5,6,7]
Summary
Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second most frequent cause of cancer-related deaths and has been estimated to be responsible for approximately 810,000 deaths per year worldwide [1]. For patients with preserved liver function, treatment procedures such as surgical resection, radiofrequency ablation, transarterial chemoembolization (TACE), and molecular targeted therapy are recommended according to their tumor stage [2]. Conventional TACE has been recommended as the first-line treatment for patients with intermediate-stage or the Barcelona. In patients who became refractory to repeated TACE, a treatment switch to multi-targeted tyrosine kinase inhibitors (TKIs) such as sorafenib or lenvatinib has been considered [3]. Deterioration of liver function from Child-Pugh grade A (CP-A) to B leads to missing the timing of treatment switch to TKIs because the efficacy and safety of TKIs are not guaranteed in patients with CP grade B (CP-B) [3,5,6,7].
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