Understanding the Impact of Liver Disease Etiology on Child-Pugh Grade Deterioration Post-TACE in HCC Patients

Transarterial chemoembolization (TACE) is a common initial treatment for hepatocellular carcinoma (HCC), a prevalent type of liver cancer. However, the effectiveness of this treatment and its impact on patients' health can vary significantly, depending on several factors. One of these factors, as recent studies suggest, is the etiology of liver disease in patients undergoing TACE. This article delves into the influence of liver disease's etiology on Child-Pugh grade deterioration post-TACE in HCC patients.

The Study and Its Key Findings

A study investigated the etiology of liver disease in 262 patients with HCC and its influence on Child-Pugh grade deterioration after TACE. The patients were divided into three groups based on the etiology of their underlying liver disease: the hepatitis B virus (HBV) group, the hepatitis C virus (HCV) group, and the non-HBV, non-HCV (NBNC) group. The study found that rates of complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) did not significantly differ among the three etiology groups. However, the NBNC group showed a significant decrease in albumin after initial TACE and had a shorter time to Child-Pugh grade deterioration and poorer prognosis compared to the HBV and HCV groups.

Factors Associated with Child-Pugh Grade Deterioration and Overall Survival

The study also identified several factors associated with Child-Pugh grade deterioration and overall survival. These included the presence of sarcopenia, alfa-fetoprotein (AFP), des-gamma-carboxy prothrombin (DCP), Child-Pugh score, NBNC group, ALBI grade, and the patient's response to treatment. These findings suggest that understanding these factors could play a crucial role in predicting treatment outcomes for HCC patients undergoing TACE.

Correlation between Non-Tumoral Liver Volume and Child Pugh Score

An additional study discussed the correlation between non-tumoral liver volume (NTLV) by computed tomography (CT) volumetry and indocyanine green retention at 15 minutes (ICG r15), Child Pugh score (CTP), and model for end-stage liver diseases (MELD) score in cirrhotic patients having HCC and in cirrhotics without HCC. The study found that NTLV had a good and significant negative correlation with ICG r15, CTP, and MELD scores in cirrhotic patients with HCC but not in cirrhotic patients without HCC. This finding suggests that CT volumetry can be a valuable tool to predict the functional hepatic volume in patients with cirrhosis and HCC who are subjected to hepatectomy where ICG r15 is not available, but further studies are needed to validate the findings in cirrhotic-only patients.

Conclusion: Etiology of Liver Disease and Child-Pugh Grade Deterioration

In conclusion, the etiology of liver disease in HCC patients appears to significantly influence Child-Pugh grade deterioration after TACE. Notably, the NBNC group seems to have a shorter time to Child-Pugh grade deterioration and a poorer prognosis compared to the HBV and HCV groups. Furthermore, several factors, including the presence of sarcopenia, AFP, DCP, Child-Pugh score, NBNC group, ALBI grade, and the patient's response to treatment, are associated with Child-Pugh grade deterioration and overall survival. As we continue to seek effective treatment strategies for HCC, these findings provide invaluable insights that could potentially enhance patient care and improve survival outcomes.