Analysis Of Risk Factors For Common Complications After TACE In Primary Liver Cancer

Objective: To retrospectively analyze the complications of patients with primary liver cancer(PLC)after transarterial chemoembolization(TACE)for the first time,and to analyze the risk factors of common complications.To provide clinical reference for the prevention and treatment of complications after TACE for primary hepatocellular carcinoma.Methods:A retrospective study was conducted to collect the clinical data of patients with HCC who were diagnosed and underwent TACE treatment for the first time in the Affiliated Hospital of Youjiang Medical College for Nationalities from September 2017 to May 2022.The collected and recorded data included personal data: gender,age,height,weight,smoking,drinking,and BMI.Past medical history: diabetes mellitus and hypertension,hepatitis B,liver cirrhosis,gallstones,portal hypertension,splenomegaly,ascites and collateral circulation.Clinical data: liver function classification before treatment,tumor pathological classification,whether the tumor was multiple,distant metastasis or not.The levels of alpha-fetoprotein,carbohydrate antigen 125,carbohydrate antigen 153,carbohydrate antigen 199,white blood cells,neutrophils,lymphocytes,monocytes,red blood cells,hemoglobin,platelet,total bilirubin,direct bilirubin,indirect bilirubin,albumin,alkaline phosphatase,glutamyl transpeptidase,creatinine,prealbumin,fecal occult blood,and coagulation symptoms were detected before operation State of the body;serum inflammatory markers included aspartate aminotransferase/lymphocyte count ratio,neutrophil count X gamma-glutamyl transpeptidase/lymphocyte count,and systemic immune inflammation index(neutrophils × monocytes/lymphocytes).Aspartate aminotransferase-to-platelet ratio index,lymphocyte/monocyte ratio.According to the presence or absence of complications after TACE treatment,the patients were divided into complication group and control group.The measurement data between the two groups were analyzed by t test,and the count data were analyzed by chi-squared test.Then binary Logistic regression analysis was used to analyze the related factors.When P<0.05,it was statistically significant.Results:(1)This study collected the data of 537 patients,and 256 patients with primary liver cancer were included in the study after excluding patients who did not meet the inclusion criteria.There were 182 patients with complications after treatment.159 patients(62.11%)had liver function damage;71 patients(27.73%)had post-embolism syndrome.Other complications included upper gastrointestinal bleeding(16 cases,6.25%);11 patients(4.30%)had acute liver failure;Renal dysfunction in 9 cases(3.52%);Cholecystitis in 8 cases(3.12%);7 cases of liver abscess(2.73%);Arrhythmia in 4 cases(1.56%);2(0.78%)had liver rupture and hemorrhage;1(0.39%)had bone marrow suppression.There were 74 patients with two or more complications,accounting for 28.90% of the total number of patients.Among them,34 patients had liver function damage and post-embolism syndrome at the same time.All patients with acute liver failure,9 patients with gastrointestinal bleeding,6 patients with cholecystitis,and 3 patients with liver abscess had concurrent liver dysfunction.Two patients who had cardiac arrhythmias and one who had upper gastrointestinal bleeding were also patients who had the post-embolization syndrome.Other complications such as liver necrosis,liver abscess,and hepatic artery intimal injury and dissection were not observed.(2)Patients were divided into a group with impaired liver function and a control group based on the type of common complications present;Post-embolism syndrome group and control group respectively.The difference between the complication group and the control group was analyzed using a t-test for the measurement data and a chi-square test for the count data.There were significant differences between the liver function impairment group and the control group in the history of drinking before treatment,presence of ascites,presence of cirrhosis,albumin,prealbumin,liver function grading before treatment,and pathological classification of tumors(P<0.05).There were significant differences between the post-embolization syndrome group and the control group in gender,height,weight,history of drinking before treatment,prealbumin,and liver function classification before treatment(P<0.05).Among the rare complications,there was a significant difference in liver function grading between the upper gastrointestinal bleeding group and the control group before treatment(P<0.05).There were significant differences in the presence of cirrhosis and portal vein tumor thrombus before treatment between the acute liver failure group and the control group(P<0.05).There was a significant difference between the cholecystitis group and the control group in the presence of portal vein tumor thrombus before treatment(P<0.05).There was a significant difference between the liver abscess group and the control group in the history of diabetes before treatment(P<0.05).Other complications were not correlated in this study.(3)Binary Logistic regression analysis was used to analyze the related factors of common complications after TACE treatment,and the results showed that: Drinking history(OR=3.757,95%CI:2.162-6.528),liver function grade B(OR=3.323,95%CI:2.964-6.470),tumor pathological type of giant(OR=2.533,95%CI:2.162-6.528),were the related risk factors affecting the occurrence of liver function damage complications after TACE treatment(P<0.05).Prealbumin(OR=0.994,95%CI:0.990-0.999)was a related protective factor for the complications of post-embolization syndrome after TACE treatment(P<0.05).Conclusion:(1)The incidence of complications after TACE was 71.09%.The common complications are liver function damage(62.11%)and post-embolization syndrome(27.73%).Other complications included upper gastrointestinal bleeding(6.25%),acute liver failure(4.30%),renal dysfunction(3.52%),cholecystitis(3.12%),liver abscess(2.73%),arrhythmia(1.56%),liver rupture and bleeding(0.78%),and bone marrow suppression(0.39%).(2)Univariate analysis show that the influencing factors of complications after TACE treatment are drinking history,diabetes history,portal vein tumor thrombus,ascites,liver cirrhosis,albumin,prealbumin,liver function classification before treatment,pathological classification of tumor,gender,height and weight of patients.(3)Binary Logistic regression analysis show that drinking history,liver function grade B,tumor pathological type of giant are independent risk factors for liver function damage after TACE treatment.Prealbumin level is a protective factor for post-embolization syndrome after TACE treatment.