A prediction model for liver abscess developing after transarterial chemoembolization in patients with hepatocellular carcinoma

Abstract

Background: Liver abscess is a rare but potentially fatal complication of transarterial chemoembolization. Other than for biliary abnormalities, risk factors for liver abscess formation after transarterial chemoembolization have rarely been discussed.

Aims: To identify other risk factors of liver abscess after transarterial chemoembolization in patients with hepatocellular carcinoma.

Methods: Data for 5299 patients with hepatocellular carcinoma who underwent transarterial chemoembolization from July 1999 to December 2009 were retrospectively reviewed. 72 patients who experienced liver abscess after transarterial chemoembolization were enrolled as a case group, which was compared with a randomly selected control group (n=1009) of patients who did not develop liver abscess after transarterial chemoembolization.

Results: Pneumobilia, type 2 biliary abnormality, type 1 biliary abnormality, diabetes mellitus, tumour number (≥3), tumour size (≥3cm), and tumour necrosis on the pre-transarterial chemoembolization computed tomography, and gelfoam embolization and vessel injury during transarterial chemoembolization were all significant predisposing factors for liver abscess after transarterial chemoembolization. A prediction model for postembolization liver abscess was developed from these risk factors.

Conclusion: The group of patients with risk scores greater than 71 showed a significantly increased risk of liver abscess after transarterial chemoembolization. These high-risk patients should be monitored carefully after transarterial chemoembolization.

Keywords: Hepatocellular carcinoma; Liver abscess; Transarterial chemoembolization.