Abstract
OBJECTIVE: To identify clinical predictors of liver function impairment and post-embolization syndrome (PES) following transcatheter arterial chemoembolization (TACE) in patients with primary hepatic carcinoma (PHC), to facilitate risk stratification and improve clinical outcomes. METHODS: A retrospective study was conducted on 549 PHC patients who underwent TACE at Eastern Hepatobiliary Surgery Hospital, Naval Military Medical University from June 2020 to January 2024. Data on demographics, liver function, imaging findings, and TACE regimens were collected. Multivariate Logistic regression analysis was employed to identify the independent risk factors for liver function impairment and PES. The predictive performance of these factors was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: Among the 549 PHC, 61.93% (340/549) developed liver function impairment and 26.96% (148/549) experienced PES after TACE. ROC analysis indicated that alcohol consumption, cirrhosis, liver function grade, and TACE frequency demonstrated predicted value for liver impairment (AUCs: 0.565-0.619) and PES (AUCs: 0.581-0.656). Multivariate logistic regression identified neutrophils (OR=2.349, P=0.001), prealbumin (PA) (OR=1.674, P=0.028), liver function grade (OR=3.135, P<0.001), alcohol consumption (OR=0.296, P<0.001), cirrhosis (OR=0.528, P=0.005), and TACE frequency (OR=0.482, P=0.001) as independent predictors for liver impairment; For PES, alcohol consumption (OR=1.959, P=0.003), body mass index (BMI) (OR=0.288, P<0.001), albumin (ALB) (OR=0.384, P=0.005), PA (OR=0.288, P<0.001), and ECOG score (OR=0.527, P=0.006) were identified as the independent predictors, whereas liver function grade (P=0.287) and TACE frequency (P=0.634) were not. Nomograms based on these predictors demonstrated good discriminative ability (AUC=0.854 for liver impairment; AUC=0.826 for PES) and satisfactory calibration (P>0.05), with consistent performance in both training and validation cohorts (AUC: 0.852-0.854 for liver impairment; 0.820-0.843 for PES). CONCLUSION: Key clinical variables, including alcohol consumption, cirrhosis, and specific biochemical markers, are significantly associated with liver function impairment and PES following TACE in PHC patients. These findings support the development of individualized treatment strategies to improve patient outcomes.