Construction And Validation Of The Nomogram Of Liver Failure After TACE In Hepatocellular Carcinoma Patients With A Diameter Of More Than 5cm Based On Hepatitis B

ObjectiveTo establish a prediction model of liver failure after transcatheter arterial chemoembolization(TACE)in liver cancer patients with a diameter of more than 5cm based on hepatitis B,and to evaluate its clinical effectiveness.MethodClinical data of 324 patients with liver cancer who received TACE treatment in the Second Affiliated Hospital of Chongqing Medical University from August 2018 to September 2020 and who met the inclusion criteria and exclusion criteria were retrospectively reviewed.ResultThe modeling population(n=240)and the verification population(n=84)were divided into two groups according to the ratio of 3∶ 1 by random number table method,and the clinical data of the two groups were compared.The modeling population was divided into liver failure group(n=36)and non-liver failure group(n=204)according to the existence of liver failure within 1 month after TACE.The independent influencing factors of liver failure after TACE in HCC patients with a diameter of more than 5cm based on hepatitis B were screened successively through univariate and multivariate Logistic regression analysis,and these factors were included and a nomogram prediction model was established.The nomogram was validated internally and externally in the modeling population and the verification population respectively: The area under the receiver-operating characteristic(AUROC)curve was used to verify the model differentiation;Hosmer-Lemeshow test and DCA curves were used to verify the model calibration;and the clinical validity of the model.Results: 36 of the 240 patients with HCC developed liver failure after TACE,with an incidence of 15%.Univariate analysis showed that cirrhosis,portal vein invasion,tumor diameter,preoperative Glutamate alanine aminotransferase(AST),international normalized ratio(INR),Prothrombin activity(PTA),bilirubin,serum sodium,prothrombin time,preoperative hemoglobin and Albumin(ALB)were risk factors for liver failure after TACE [P<0.05,P(portal vein invasion)=0.053].Multivariate logistic regression analysis showed that portal vein invasion,AST,INR,and tumor diameter greater than 10 cm were independent risk factors,and ALB below baseline were independent protective factor.ConclusionThe incidence of liver failure is not low in HCC patients with a diameter of more than 5cm based on hepatitis B after TACE.Taking appropriate measures against related risk factors is helpful to reduce the occurrence of liver failure after TACE.