Hepatic Function during Repeated TACE Procedures and Prognosis after Introducing Sorafenib in Patients with Unresectable Hepatocellular Carcinoma: Multicenter Analysis

<b><i>Background/Aim:</i></b> We evaluated the relationship of hepatic function with repeated transarterial catheter chemoembolization (TACE) and prognosis after sorafenib treatment in various patient cohorts. <b><i>Methods:</i></b> Study 1 comprised of 212 Barcelona clinic liver cancer stage-B (BCLC-B) HCC patients classified as Child-Pugh A (CP-A) and who had received repeated TACE treatments (r-TACE) (naïve:recurrence = 66:146). Study 2 comprised of 435 patients with unresectable HCC classified as CP-A in who sorafenib was introduced (naïve:recurrence = 37:398; CP score 5:6 = 282:153; macro-vessel invasion [MVI]+: extrahepatic metastasis [EHM]+ both negative = 124:226:143). Changes in hepatic function along with CP and albumin-bilirubin (ALBI) score/grade during r-TACE in Study 1, and prognosis after introducing sorafenib in Study 2 were evaluated. <b><i>Results:</i></b> Hepatic function worsened to CP-B in 9-14% with each TACE procedure, while 18-21% had a change of classification from ALBI-1 to ALBI-2. When the prognosis of patients with the best CP score of 5 was analyzed, those with ALBI-1 (<i>n</i> = 154) had a better outcome than those with ALBI-2 (<i>n</i> = 128) (MST 17.5 vs. 9.9 months; <i>p</i> = 0.01), while ALBI-1 (<i>n</i> = 43) patients also showed a better outcome than ALBI-2 (<i>n</i> = 34) patients with a CP score of 5 without MVI/EHM (MST: 17.5 vs. 10.0 months; <i>p</i> = 0.029). The Akaike's Information criterion for ALBI-grade (MST: grade 1 vs. 2 = 16.9 vs. 10.4 months; <i>p</i> = 0.001) was also better than that for CP (MST: score 5 vs. 6 = 14.4 vs. 10.5 months; <i>p</i> = 0.003) (3195.6 vs. 3197.5) in all 435 patients. <b><i>Conclusion:</i></b> The rate of patients with downgraded hepatic function during r-TACE, especially with regard to ALBI-grade, was not low. ALBI-grade was shown to be a better hepatic function assessment tool than CP in patients receiving sorafenib treatment. Strict judgment of TACE-refractory status in patients with unresectable HCC is needed to improve prognosis before downgrading the hepatic function.