Abstract
Purpose: To retrospectively review the ability of direct bilirubin serum level to predict mortality and complications in patients undergoing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) and compare it to the predictive value of the currently utilized total bilirubin serum level. Materials and methods: A total of 219 patients who underwent TACE for 353 hepatocelluar carcinomas (HCC) at a single institution were included. There were 165 men and 54 women, with a mean age of 61.4 ± 7.6 (SD) [range: 27–86 years]. The patients’ electronic medical records were evaluated and they were divided into cohorts based on total bilirubin (< 2, 2–3, and > 3 mg/dL) as well as direct bilirubin (< 1 and 1–2 mg/dL). Results: Direct bilirubin serum level was significantly greater in the cohort of patients who did not survive as compared to those who survived 6 months ([0.58 ± 0.46 (SD) mg/dL; range: < 0.1–1.8 mg/dL] vs. [0.40 ± 0.31 (SD) mg/dL; range: < 0.1–1.6 mg/dL], respectively) (P = 0.04) and 12 months ([0.49 ± 0.38 (SD) mg/dL; range: < 0.1–1.8 mg/dL] vs. [0.38 ± 0.32 (SD) mg/dL; range: < 0.1–1.6 mg/dL], respectively) (P = 0.03). While total bilirubin serum level was not significantly different in those who did not and did survive 6 months ([1.54 ± 0.99 (SD) mg/dL; range: 0.3–3.9 mg/dL] vs. [1.27 ± 0.70 (SD) mg/dL; range: 0.3–3.75 mg/dL], respectively) (P = 0.16), it was significantly different when evaluating 12 months survival ([1.46 ± 0.87 (SD) mg/dL; range: 0.3–3.9 mg/dL] vs. [1.22 ± 0.65 (SD) mg/dL; range: 0.3–3.9 mg/dL]) (P = 0.03). Akaike information criterion (AIC) analysis revealed that direct bilirubin level more accurately predicted overall survival (AIC = 941.19 vs. 1000.51) and complications (AIC = 352.22 vs. 357.42) than total bilirubin serum levels. Conclusion: Direct bilirubin serum level appears to outperform total bilirubin concentration for predicting complications and overall survival in patients undergoing TACE. Patients with relatively maintained direct bilirubin levels should be considered for TACE, particularly in the setting of bridging to transplant.
Original language | English (US) |
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Pages (from-to) | 355-364 |
Number of pages | 10 |
Journal | Diagnostic and Interventional Imaging |
Volume | 101 |
Issue number | 6 |
DOIs | |
State | Published - Jun 2020 |
Bibliographical note
Funding Information:Research reported in this publication was supported by NIH grant P30 CA77598 utilizing the Biostatistics and Bioinformatics Core shared resource of the Masonic Cancer Center, University of Minnesota and by the National Center for Advancing Translational Sciences of the National Institutes of Health Award Number UL1TR000114. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2020 Société française de radiologie
Keywords
- Bilirubin
- Chemoembolization
- Cohort studies
- Ethiodized oil
- Hepatocellular carcinoma