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High-Risk Factors and Prognostic Modeling for Short-Term Death Following TACE in Liver Cancer Patients
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  • Youwu Hu,
  • Wanqing Liu,
  • WanDi Fang,
  • Hong Zhang,
  • Yudi Dong,
  • Feng Li,
  • Rongshu Shi,
  • Kaifei Zhao,
  • Qing Luo
Youwu Hu
Affiliated Hospital of Zunyi Medical University
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Wanqing Liu
Affiliated Hospital of Zunyi Medical University
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WanDi Fang
Affiliated Hospital of Zunyi Medical University
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Hong Zhang
Affiliated Hospital of Zunyi Medical University
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Yudi Dong
Affiliated Hospital of Zunyi Medical University
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Feng Li
Affiliated Hospital of Zunyi Medical University
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Rongshu Shi
Affiliated Hospital of Zunyi Medical University
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Kaifei Zhao
Affiliated Hospital of Zunyi Medical University
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Qing Luo
Affiliated Hospital of Zunyi Medical University

Corresponding Author:zlsysluoqing@163.com

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Abstract

Purpose: The risk factors fordeath at different intervals (6 months, 6-12 months, and 12-18 months) following TACE in 213 HCC patients were analyzed, leading to the establishment of a prognostic risk model for these patients. Patients and Methods: Liver cancer patients who underwent TACE at Zunyi Medical University between April 2011 and June 2019 were included in the study. Collected clinical data included AFP levels, demographics, tumor characteristics, treatment details, and liver function markers. The study tracked patients from their first admission to their last follow-up or death, with a median follow-up duration of 7.4 months. Logistic and Cox regression analyses were performed to evaluate death at different post-surgery intervals, and survival differences were assessed using the Kaplan-Meier method. A prognostic nomogram was developed and validated using the C-index, ROC curves, and calibration curves to assess model performance. Results: At the end of the follow-up, 39 out of 213 patients survived, while 174 had died, with a median survival time of 6 months. Logistic regression analysis identified AST/ALT > 1 and HBV positivity as risk factors for death within 6 months post-TACE, Child-Pugh grade B at 6-12 months, and multiple tumors at 12-18 months. Cox regression analysis showed that portal vein thrombosis, multiple tumors, tumors in both liver lobes, distant metastasis, elevated white blood cell and neutrophil counts, AST/ALT > 1, low albumin, HBV positivity, Okuda grade II, Child-Pugh grade C, and BCLC grade C were significant factors affecting overall survival (P < 0.05). Key independent risk factors were portal vein thrombosis, AST/ALT > 1, and Child-Pugh grade C, while more than two TACE treatments served as a protective factor. Key independent risk factors were portal vein thrombosis, AST/ALT > 1, and Child-Pugh grade C, while more than two TACE treatments served as a protective factor. Conclusions: Our study identifies high-risk factors for death following TACE, including AST/ALT > 1, HBV positivity, Child-Pugh class B, and multiple tumors at different time intervals. A 13-variable nomogram was developed, demonstrating strong predictive ability and potential for clinical application to enhance patient prognosis and survival.
26 Aug 2024Submitted to Cancer Reports
27 Aug 2024Submission Checks Completed
27 Aug 2024Assigned to Editor
27 Aug 2024Review(s) Completed, Editorial Evaluation Pending
02 Sep 2024Reviewer(s) Assigned