{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T03:03:30Z","timestamp":1760151810762,"version":"build-2065373602"},"reference-count":35,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T00:00:00Z","timestamp":1663718400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Wilhelm Laupitz Foundation","award":["108-21280"],"award-info":[{"award-number":["108-21280"]}]},{"name":"Humedics","award":["108-21280"],"award-info":[{"award-number":["108-21280"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background and Aims: Radioembolization (RE) has recently demonstrated a non-inferior survival outcome compared to systemic therapy for advanced hepatocellular carcinoma (HCC). Therefore, current guidelines recommend RE for patients with advanced HCC and preserved liver function who are unsuitable for transarterial chemoembolization (TACE) or systemic therapy. However, despite the excellent safety profile of RE, post-therapeutic hepatic decompensation remains a serious complication that is difficult to predicted by standard laboratory liver function parameters or imaging modalities. LiMAx\u00ae is a non-invasive test for liver function assessment, measuring the maximum metabolic capacity for 13C-Methacetin by the liver-specific enzyme CYP 450 1A2. Our study investigates the potential of LiMAx\u00ae for predicting post-interventional decompensation of liver function. Patients and methods: In total, 50 patients with HCC with or without liver cirrhosis and not amenable to TACE or systemic treatments were included in the study. For patients prospectively enrolled in our study, LiMAx\u00ae was carried out one day before RE (baseline) and 28 and 90 days after RE. Established liver function parameters were assessed at baseline, day 28, and day 90 after RE. The relationship between baseline LiMAx\u00ae and pre-and post-interventional liver function parameters, as well as the ability of LiMAx\u00ae to predict hepatic decompensation, were analyzed. Results: We observed a strong association between baseline LiMAx\u00ae and bilirubin, albumin, ALBI grade, and MELD score. Patients presenting with Child\u2013Pugh score B 28 days after RE or with a deterioration in Child\u2013Pugh score by at least one point had a significantly lower baseline LiMAx\u00ae compared to those with Child\u2013Pugh score A or with stable Child\u2013Pugh score. The ability of LiMAx\u00ae to predict hepatic decompensation after RE was determined using ROC curve analysis and was compared to MELD score and ALBI grade. LiMAx\u00ae achieved a substantial AUC of 0.8117, comparable to MELD score and ALBI grade. Conclusion: Patients with lower LiMAx\u00ae values at baseline have a significantly increased risk for hepatic decompensation after RE, despite being categorized as Child\u2013Pugh A. Therefore, LiMAx\u00ae can be used as an additional tool to identify patients at high risk of post-interventional hepatic failure.<\/jats:p>","DOI":"10.3390\/cancers14194584","type":"journal-article","created":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T21:22:23Z","timestamp":1663795343000},"page":"4584","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["LiMAx Prior to Radioembolization for Hepatocellular Carcinoma as an Additional Tool for Patient Selection in Patients with Liver Cirrhosis"],"prefix":"10.3390","volume":"14","author":[{"given":"Catherine","family":"Leyh","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, 45147 Essen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niklas","family":"Heucke","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, and Infectious Diseases, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clemens","family":"Schotten","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, 45147 Essen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3394-5492","authenticated-orcid":false,"given":"Matthias","family":"B\u00fcchter","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, 45147 Essen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars P.","family":"Bechmann","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, 44892 Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marc","family":"Wichert","sequence":"additional","affiliation":[{"name":"Central Laboratory, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Dech\u00eane","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine 6, Paracelsus Medical University N\u00fcrnberg, 90419 N\u00fcrnberg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ken","family":"Herrmann","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University Hospital Essen, 45147 Essen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominik","family":"Heider","sequence":"additional","affiliation":[{"name":"Department of Mathematics and Computer Science, Philipps University of Marburg, 35032 Marburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1349-8309","authenticated-orcid":false,"given":"Svenja","family":"Sydor","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, 44892 Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Lemmer","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, and Infectious Diseases, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes M.","family":"Ludwig","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josef","family":"Pospiech","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, 44892 Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5869-7929","authenticated-orcid":false,"given":"Jens","family":"Theysohn","sequence":"additional","affiliation":[{"name":"Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147 Essen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Damm","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"March","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maciej","family":"Powerski","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7140-6775","authenticated-orcid":false,"given":"Maciej","family":"Pech","sequence":"additional","affiliation":[{"name":"Department of Radiology and Nuclear Medicine, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mustafa","family":"\u00d6zc\u00fcr\u00fcmez","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, 44892 Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jochen","family":"Weigt","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, and Infectious Diseases, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Verena","family":"Keitel","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, and Infectious Diseases, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian M.","family":"Lange","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, 45147 Essen, Germany"},{"name":"Department of Internal Medicine II, LMU University Hospital Munich, 81377 Munich, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2402-7764","authenticated-orcid":false,"given":"Hartmut","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, 45147 Essen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6069-7899","authenticated-orcid":false,"given":"Ali","family":"Canbay","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, 44892 Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Best","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology, and Infectious Diseases, Otto-von-Guericke University Magdeburg, 39120 Magdeburg, Germany"},{"name":"Department of Internal Medicine, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, 44892 Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guido","family":"Gerken","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Hepatology and Transplant Medicine, University Hospital Essen, 45147 Essen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul P.","family":"Manka","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, 44892 Bochum, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1002\/hep.31288","article-title":"Epidemiology of Hepatocellular Carcinoma","volume":"73","author":"McGlynn","year":"2021","journal-title":"Hepatology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.jhep.2018.03.019","article-title":"EASL Clinical Practice Guidelines: Management of Hepatocellular Carcinoma","volume":"69","author":"Galle","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"iv238","DOI":"10.1093\/annonc\/mdy308","article-title":"Hepatocellular Carcinoma: ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up","volume":"29","author":"Vogel","year":"2018","journal-title":"Ann. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/j.annonc.2021.02.014","article-title":"Updated Treatment Recommendations for Hepatocellular Carcinoma (HCC) from the ESMO Clinical Practice Guidelines","volume":"32","author":"Vogel","year":"2021","journal-title":"Ann. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1053\/j.gastro.2010.10.049","article-title":"Radioembolization Results in Longer Time-to-Progression and Reduced Toxicity Compared With Chemoembolization in Patients With Hepatocellular Carcinoma","volume":"140","author":"Salem","year":"2011","journal-title":"Gastroenterology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1016\/j.cgh.2013.04.028","article-title":"Increased Quality of Life Among Hepatocellular Carcinoma Patients Treated With Radioembolization, Compared With Chemoembolization","volume":"11","author":"Salem","year":"2013","journal-title":"Clin. Gastroenterol. 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Nutr."}],"container-title":["Cancers"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/19\/4584\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:36:53Z","timestamp":1760143013000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6694\/14\/19\/4584"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,21]]},"references-count":35,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["cancers14194584"],"URL":"https:\/\/doi.org\/10.3390\/cancers14194584","relation":{},"ISSN":["2072-6694"],"issn-type":[{"type":"electronic","value":"2072-6694"}],"subject":[],"published":{"date-parts":[[2022,9,21]]}}}