{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,13]],"date-time":"2025-10-13T20:04:44Z","timestamp":1760385884495,"version":"3.40.5"},"reference-count":25,"publisher":"S. Karger AG","issue":"1","license":[{"start":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T00:00:00Z","timestamp":1638230400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T00:00:00Z","timestamp":1638230400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["GE Port J Gastroenterol"],"published-print":{"date-parts":[[2023]]},"abstract":"<jats:p>Introduction: Transarterial chemoembolization (TACE) is the first-line treatment for patients with intermediate-stage hepatocellular carcinoma (HCC). For patients without an adequate response, current finding suggests that treatment with molecular target agents, approved for advanced stage, might present benefits. However, this requires a preserved liver function. This study aims to evaluate possible predictors of early deterioration of hepatic reserve, prior to TACE refractoriness, in a cohort of patients treated with TACE. Methods: Retrospective analysis of 99 patients withChild-Pugh class A and intermediate-stage HCC who underwent TACE as the first-line treatment. All patients were submitted to a biochemical and medical evaluation prior to initial TACE and every month afterward. Response to initial TACE was evaluated at 1 month. The time to Child-Pugh class deterioration before TACE refractoriness was assessed. Results: Ninety-nine patients were included. Objective response rate (ORR) to initial TACE was assessed as present in 59 (63.4%) and as absent in 34 (36.6%) patients. Liver decompensated before TACE refractoriness in 51 (51.5%) patients, and the median time to liver decompensation was 14 (IQR 8\u201320) months after first TACE. In multivariate analysis, beyond up-to-7 criteria (HR 2.4, p = 0.031), albumin &lt;35 mg\/dL (HR 3.5, p &lt; 0.001) and absence of ORR (HR 2.4, p = 0.020) were associated with decreased overall survival free of liver decompensation. Moreover, beyond up-to-7 criteria, albumin &lt;35 mg\/dL and absence of ORR associated negatively with 6-month survival free of liver decompensation. Our model created using those variables was able to predict liver decompensation at 6 months with an AUROC of 0.701 (p = 0.02). Conclusions: The absence of ORR after initial TACE, beyond up-to-7 criteria and albumin &lt;35 mg\/dL, was a predictive factor for early liver decompensation before TACE refractoriness in our population. Such patients might benefit from treatment escalation to systemic therapy, in monotherapy or in combination with TACE. <\/jats:p>","DOI":"10.1159\/000520530","type":"journal-article","created":{"date-parts":[[2021,11,30]],"date-time":"2021-11-30T22:01:09Z","timestamp":1638309669000},"page":"29-37","source":"Crossref","is-referenced-by-count":2,"title":["Development of a Model to Predict Liver Decompensation prior to Transarterial Chemoembolization Refractoriness in Patients with Intermediate-Stage Hepatocellular Carcinoma"],"prefix":"10.1159","volume":"30","author":[{"given":"Joel","family":"Ferreira-Silva","sequence":"first","affiliation":[]},{"given":"Pedro","family":"Costa-Moreira","sequence":"additional","affiliation":[]},{"given":"Helder","family":"Cardoso","sequence":"additional","affiliation":[]},{"given":"Rodrigo","family":"Liberal","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9317-8734","authenticated-orcid":false,"given":"Pedro","family":"Pereira","sequence":"additional","affiliation":[]},{"given":"Guilherme","family":"Macedo","sequence":"additional","affiliation":[]}],"member":"127","published-online":{"date-parts":[[2021,11,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.03.007"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ctrv.2010.07.006"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/S0168-8278(12)60009-9"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29913"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2012.01.008"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31187"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2012.06.014"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1159\/000365993"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1159\/000367743"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2019-318934"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1159\/000480256"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14569"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/S1053-4296(03)00031-6"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1159\/000343875"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgast-2015-000032"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.13048"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.3390\/cancers11030405"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.rx.2010.07.010"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-015-1480-x"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1177\/2050640616673516"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinre.2016.05.005"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000001659"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-019-5989-2"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-020-0265-0"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.dld.2014.07.012"}],"container-title":["GE - Portuguese Journal of Gastroenterology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/pjg\/article-pdf\/30\/1\/29\/3960796\/000520530.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/karger.com\/pjg\/article-pdf\/30\/1\/29\/3960796\/000520530.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,23]],"date-time":"2025-04-23T15:30:14Z","timestamp":1745422214000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/000520530"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,30]]},"references-count":25,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1,20]]},"published-print":{"date-parts":[[2023,8,8]]}},"URL":"https:\/\/doi.org\/10.1159\/000520530","archive":["Portico"],"relation":{},"ISSN":["2341-4545","2387-1954"],"issn-type":[{"type":"print","value":"2341-4545"},{"type":"electronic","value":"2387-1954"}],"subject":[],"published":{"date-parts":[[2021,11,30]]}}}