Abstract
The purpose of this study was to investigate the effect of acute kidney injury (AKI) on the prognosis of patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). A total of 347 HCC patients with Child-Pugh class A and pre-TACE serum creatinine (SCr) ≤1.5 mg/dL undergoing TACE as an initial therapy 2000-2014 were analyzed. Overall survival with related risk factors including AKI was investigated. We assessed AKI based on the International Club of Ascites (ICA)-AKI criteria. The mean age was 60.9 years. Of 347 patients, death was observed in 109 patients (31.4%). The mean SCr levels at pre-TACE, one day, two months, and four months after TACE were 0.9, 0.9, 0.9, and 1.1 mg/dL, respectively. The AKI within four months after TACE developed in 37 patients (11%). The AKI stages were non-AKI in 310 (89%), stage 1 in 10 (3%), stage 2 in 10 (3%), and stage 3 in 17 patients (5%). Multivariable analysis showed that the risk factors for overall survival were serum albumin ≤3.5 g/dL (hazard ratio [HR] 1.58, p = 0.027), BCLC stage B (HR 2.07, p = 0.008), BCLC stage C (HR 3.96, p<0.001), bilobar tumor location (HR 1.66, p = 0.022), AKI stage 1 (HR 6.09, p<0.001), AKI stage 2 (HR 8.51, p<0.001), and AKI stage 3 (HR 17.64, p<0.001). AKI is a crucial prognostic factor for overall survival in HCC patients undergoing TACE. The assessment of AKI based on the ICA-AKI criteria can facilitate evaluation of the prognosis of HCC patients undergoing TACE.
Highlights
Hepatocellular carcinoma (HCC) is one of the most common malignancies and its mortality rate is 8.2% of all cancer-related deaths globally [1]
The purpose of this study was to investigate the effect of acute kidney injury (AKI) on the prognosis of HCC patients undergoing transarterial chemoembolization (TACE) based on the International Club of Ascites (ICA)-AKI criteria
This study indicated that serum albumin level, tumor stage, bilobar location of tumor, and AKI stage significantly associated with overall survival in HCC patients who underwent TACE
Summary
Hepatocellular carcinoma (HCC) is one of the most common malignancies and its mortality rate is 8.2% of all cancer-related deaths globally [1]. The prognosis of HCC depends on the liver function of patients as well as the tumor burden. The Barcelona Clinic Liver Cancer (BCLC) staging system, considering liver function and tumor burden, has been widely used to determine the treatment modality or to assess the prognosis of the patients with HCC [2, 3]. HCC mostly develops on a background of chronic liver disease or liver cirrhosis [4]. The management of liver cirrhosis is crucial to improving the prognosis of patients with HCC.
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