High-Risk Factors and Prognostic Modeling for Short-Term Death Following
TACE in Liver Cancer Patients
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.