Time variation of high-risk groups for liver function deteriorations within fluctuating long-term liver function after hepatic radiotherapy in patients with hepatocellular carcinoma

Yu-Lun Tsai; Pei-Chieh Yu; Hsin-Hua Nien; Tzu-Pin Lu

doi:10.1186/s40001-024-01692-z

Time variation of high-risk groups for liver function deteriorations within fluctuating long-term liver function after hepatic radiotherapy in patients with hepatocellular carcinoma

Eur J Med Res. 2024 Feb 7;29(1):104. doi: 10.1186/s40001-024-01692-z.

Authors

Yu-Lun Tsai^{1

2}, Pei-Chieh Yu^{2

3}, Hsin-Hua Nien^{2

4

5}, Tzu-Pin Lu^{6

7

8}

Affiliations

¹ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
² Department of Radiation Oncology, Cathay General Hospital, Taipei, Taiwan.
³ School of Medicine, China Medical University, Taichung, Taiwan.
⁴ School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
⁵ Institute of Biomedical Engineering, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
⁶ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan. tplu@ntu.edu.tw.
⁷ Bioinformatics and Biostatistics Core, Center of Genomic and Precision Medicine, National Taiwan University, Taipei, Taiwan. tplu@ntu.edu.tw.
⁸ Institute of Health Data Analytics and Statistics, College of Public Health, National Taiwan University, Taipei, Taiwan. tplu@ntu.edu.tw.

Abstract

Purpose: The purpose of this study is to find essential risk factors associated with liver function (LF) deteriorations within fluctuating long-term LF and their time-varying effects in patients with hepatocellular carcinoma (HCC) receiving hepatic radiotherapy and to identify high-risk groups for adverse LF deteriorations and their changes over time in facilitating the prevention of hepatic decompensation and the improvement of survival.

Materials and methods: A total of 133 HCC patients treated by hepatic radiotherapy were enrolled. A study design was conducted to convert posttreatment long-term LF with fluctuating levels over time to recurrent LF events using defined upgrades in a grading scale. The hazard ratios (HR) of pretreatment biochemical, demographic, clinical, and dosimetric factors in developing posttreatment LF events were estimated using the Cox model. Methodologies of the counting process approach, robust variance estimation, goodness-of-fit testing based on the Schoenfeld residuals, and time-dependent covariates in survival analysis were employed to handle the correlation within subjects and evaluate the time-varying effects during long-term follow-up.

Results: Baseline LF score before radiotherapy and gender were significant factors. Initial HR in developing LF events was 1.17 (95% CI 1.11-1.23; P < 0.001) for each increase of baseline LF score and kept almost constant over time (HR, 1.00; 95% CI 1.00-1.01; P = 0.065). However, no difference was observed regarding initial hazards for gender (HR, 1.00; 95% CI 0.64-1.56; P = 0.994), but the hazard for women got higher monthly over time compared with men (HR, 1.04; 95% CI 1.01-1.07; P = 0.006).

Conclusions: High-risk groups for adverse LF deteriorations after hepatic radiotherapy may change over time. Patients with poor baseline LF are vulnerable from the beginning. Women require prevention strategies and careful monitoring for deteriorations at a later stage.

Keywords: Hepatic radiotherapy; Hepatocellular carcinoma; High-risk group; Long-term liver function; Time variation.

MeSH terms

Carcinoma, Hepatocellular* / radiotherapy
Female
Humans
Liver Cirrhosis / pathology
Liver Neoplasms* / pathology
Liver Neoplasms* / radiotherapy
Male
Proportional Hazards Models
Retrospective Studies