Change of indocyanine green clearance ability and liver function after transcatheter intraarterial therapies and its impact on outcomes of resectable hepatocellular carcinoma: a retrospective cohort study

Yi-Xiang Gan; Zi-Liang Yang; Yang-Xun Pan; Li-Ying Ou-Yang; Yu-Hao Tang; Yao-Jun Zhang; Min-Shan Chen; Li Xu

doi:10.1097/JS9.0000000000001156

Change of indocyanine green clearance ability and liver function after transcatheter intraarterial therapies and its impact on outcomes of resectable hepatocellular carcinoma: a retrospective cohort study

Int J Surg. 2024 Feb 15. doi: 10.1097/JS9.0000000000001156. Online ahead of print.

Authors

Yi-Xiang Gan¹, Zi-Liang Yang¹, Yang-Xun Pan¹, Li-Ying Ou-Yang², Yu-Hao Tang³, Yao-Jun Zhang¹, Min-Shan Chen¹, Li Xu¹

Affiliations

¹ Department of Liver Surgery, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer，Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.
² Intensive Care Unit, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer，Sun Yat-sen University Cancer Center, Guangzhou 510060, P. R. China.
³ Department of Radiation Oncology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Er Road, Guangzhou, 510080, China.

PMID: 38363991
DOI: 10.1097/JS9.0000000000001156

Abstract

Background: Indocyanine green (ICG) clearance test is a classical measurement of hepatic reserve, which involves surgical safety and patient recovery of hepatocellular carcinoma (HCC). We aim to compare effects of hepatic arterial infusion chemotherapy (HAIC) and transcatheter arterial chemoembolization (TACE) on liver function and outcomes of subsequent hepatectomy.

Material and methods: HCC patients receiving HAIC/TACE in SYSUCC with repeated ICG clearance tests were retrospectively enrolled. ICG eliminating rate (ICG-K), ICG retention rate at 15-minutes (ICG-R15) and ordinary laboratory tests were collected. Peri-therapeutic changes of values were compared between the groups. Propensity score matching (PSM) and inverse probability of treatment weighing (IPTW) were employed to validate findings. Post-hepatectomy liver failure (PHLF), overall survival (OS) and recurrence-free survival (RFS) were analyzed in patients with subsequent curative hepatectomy.

Results: 204 patients treated with HAIC (n=130) and TACE (n=74) were included. ΔICG-R15 was greater in the HAIC arm before matching (mean, 3.8% vs. 0.7%, P<0.001), after PSM (mean, 4.7% vs. 1.1%, P=0.014) and IPTW (mean, 2.0% vs. -3.6%, P<0.001). No difference was found for ΔALB, ΔALBI, ΔTBIL, ΔALT, ΔAST and ΔPT-INR. Multivariable analyses revealed elder age, cirrhosis, HAIC, greater ΔTBIL and ΔALBI were associated with deteriorating ICG-R15. Among those (105 for HAIC and 48 for TACE) receiving hepatectomy, occurrence of grade B/C PHLF (4.8% vs. 8.3%, P=0.616), OS (median, unreached vs. unreached, P=0.94) and RFS (median, 26.7 vs. 17.1 mo, P=0.096) were comparable between the two arms. In subgroup analyses, preoperative HAIC yield superior RFS (median, 26.7 vs. 16.2 mo, P=0.042) in patients with baseline ICG-R15≤10%.

Conclusion: Preoperative FOLFOX-HAIC caused apparent impairment of ICG clearance ability than TACE yet comparable impact on liver function and post-hepatectomy outcomes.