Risk Factors of Liver Dysfunction Induced by Microwave Ablation in Patients with Hepatocellular Carcinoma

Abstract

To investigate the risk factors of the aggravation of liver function induced by microwave ablation (MWA) of patients with hepatocellular carcinoma (HCC). We retrospectively reviewed the liver function of 498 patients with HCC undergoing MWA treatment. The dynamic changes of liver enzymes and Child-Pugh scores were observed. The potential risk factors, including the relative position between the tumor and portal vein (PV), tumor numbers, ablation volumes, Child-Pugh classifications, platelet, APRI and MELD scores, were analyzed. Based on the relative position between the tumor and PV, the tumors of the patients were divided into four groups, (1) far away from PV; (2) close to the third branch of PV (< 5mm); (3) close to the second branch of PV (< 5mm); (4) close to the first branch of PV (< 5mm). Complete response was achieved in 409 (98.08%) of 417 patients with tumors far away from the PV and in 89 (95.70%) of 93 patients with tumors close to a branch of the PV. Large fluctuations in the levels of ALB, ALT, AST and TBIL were observed three days after treatment, while the concentrations of ALP and γ-GGT were relative stable. 13.86% (69/498) patients suffered from liver function damage, that is, having an increase of Child-Pugh score by two three days after MWA. The incidences of liver dysfunction of the patients with tumors close to PV, more than three tumors, ablation volumes lager than or equal to 22.5 cm3, Child-Pugh classification B, APRI > 1.6, MELD > 30 or PLT < 110 × 109/L were 53.85%, 46.15%, 20.60%, 24.24%, 31.53%, 22.55% or 18.92%, respectively, much higher than those of patients without above characteristics. MWA can cause a transient deterioration of liver function. Patients with tumors close to PV, large numbers of tumors or large ablation volumes may present a great fluctuation of liver enzymes and an aggravation of liver dysfunction. In addition, poor liver reserve function is a risk factor of liver function damage but not the elevations of liver enzymes after MWA.