Liver- and tumour-specific indicators predicting suboptimal survival following repeat transarterial chemoembolisation in patients with hepatocellular carcinoma.

Introduction: This study explored liver- and tumour-specific indicators predictive of suboptimal survival outcomes following repeat transarterial chemoembolisation (TACE) in intermediate-stage hepatocellular carcinoma (HCC) patients after an initial TACE.

Methods: This study included 300 HCC patients who underwent TACE treatment. Based on whether persistent albumin-bilirubin (ALBI) grade deterioration (PABD) occurred after the initial TACE, defining as a shift in ALBI grade to a higher grade from baseline without recovery within 90 days, patients were divided into PABD and non-PABD groups. Overall survival of non-PABD and PABD groups according to subgroups stratified by baseline ALBI grade and tumour burden was compared with that of patients receiving only sorafenib or supportive care during the same period.

Results: Repeat TACE provided a survival benefit over systemic therapy or supportive care for patients in all post-TACE non-PABD or most PABD subgroups, regardless of baseline liver condition (ie, modified albumin-bilirubin [mALBI] grade and tumour burden). This benefit was absent in two subgroups among patients who developed PABD after the initial TACE, namely, (1) those with a baseline liver condition of mALBI grade 1 or 2a and tumour burden exceeding the up-to-11 criteria, and (2) those with a baseline liver condition of mALBI grade 2b, regardless of tumour burden.

Conclusion: Repeat TACE is not recommended for patients with persistent liver function deterioration after the initial TACE, particularly those exhibiting suboptimal baseline liver function or excessive tumour burden. Understanding the liver condition and tumour burden in HCC patients may assist clinicians in planning optimal treatment strategies, leading to better prognosis.