Jie XH, Xi DY, Zhang SS, Yan XB. Acute liver injury after transcatheter arterial chemoembolization in patients with hepatitis B virus-related intermediate or advanced hepatocellular carcinoma stages. World J Gastroenterol 2026; 32(24): 118709 [DOI: 10.3748/wjg.v32.i24.118709]
Corresponding Author of This Article
Xue-Bing Yan, PhD, Professor, Department of Infectious Diseases, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou 221132, Jiangsu Province, China. yxbxuzhou@126.com
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Gastroenterology & Hepatology
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research-article
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Jie XH, Xi DY, Zhang SS, Yan XB. Acute liver injury after transcatheter arterial chemoembolization in patients with hepatitis B virus-related intermediate or advanced hepatocellular carcinoma stages. World J Gastroenterol 2026; 32(24): 118709 [DOI: 10.3748/wjg.v32.i24.118709]
World J Gastroenterol. Jun 28, 2026; 32(24): 118709 Published online Jun 28, 2026. doi: 10.3748/wjg.v32.i24.118709
Acute liver injury after transcatheter arterial chemoembolization in patients with hepatitis B virus-related intermediate or advanced hepatocellular carcinoma stages
Xin-Hui Jie, De-Yang Xi, Shuang-Shuang Zhang, Xue-Bing Yan
Xin-Hui Jie, Shuang-Shuang Zhang, Graduate School, Xuzhou Medical University, Xuzhou 221006, Jiangsu Province, China
De-Yang Xi, Department of Critical Care Medicine, Xuzhou Central Hospital, Xuzhou 221009, Jiangsu Province, China
Xue-Bing Yan, Department of Infectious Diseases, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221132, Jiangsu Province, China
Co-first authors: Xin-Hui Jie and De-Yang Xi.
Author contributions: Jie XH and Xi DY share co-first authorship based on their equivalent substantive contributions to experimental execution and analytical rigor throughout this collaborative research; Jie XH contribute to data acquisition, literature screening, literature mining, and manuscript drafting; Xi DY contribute to the study design and statistical analyses; Zhang SS conducted quality assessment; Yan XB provided conceptual guidance and secured funding; all authors have reviewed and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Medical Ethics Committee of The Affiliated Hospital of Xuzhou Medical University, No. XYFY2025-KL533-01.
Informed consent statement: Given the retrospective nature of the study without active interventions, the institutional review board waived the requirement for informed consent from patients.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author. Consent was not obtained but the presented data are anonymized and risk of identification is low.
Corresponding author: Xue-Bing Yan, PhD, Professor, Department of Infectious Diseases, The Affiliated Hospital of Xuzhou Medical University, No. 99 Huaihai West Road, Xuzhou 221132, Jiangsu Province, China. yxbxuzhou@126.com
Received: January 15, 2026 Revised: February 11, 2026 Accepted: March 10, 2026 Published online: June 28, 2026 Processing time: 144 Days and 14.7 Hours
Abstract
BACKGROUND
Acute liver injury (ALI) is a prevalent complication following transcatheter arterial chemoembolization (TACE), a procedure frequently used in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). This complication may break the treatment schedule and have a negative influence on the clinical outcomes.
AIM
To determine the risk factors for post-TACE ALI and establish nomogram for personalized prediction in patients with HBV-related intermediate-to-advanced HCC.
METHODS
This retrospective study encompassed 172 patients with HBV-related intermediate to advanced HCC who underwent TACE from January 2019 to December 2024. Patients were categorized into ALI and non-ALI groups. Clinical data were collected within one week before and after TACE. A predictive nomogram was constructed based on independent risk factors identified by multivariate logistic regression. The discriminative ability, calibration, and clinical net benefit of this model were validated using receiver operating characteristic curves (area under the curve), calibration curves, and decision curve analysis.
RESULTS
The retrospective study was based on clinical and laboratory data from 172 patients with a clinical diagnosis of HBV-related HCC and who received TACE treatment. Of these, 62 patients (36.0%) developed ALI. Multivariate analysis revealed Child-Pugh stage (A vs B/C), number of TACE treatments, and HBV DNA levels (≥ 20 IU/mL) as independent predictors of ALI (P < 0.05). A nomogram incorporating these variables was developed to facilitate individualized risk assessment.
CONCLUSION
Child-Pugh stage, number of TACE treatments, and HBV DNA load are significant predictors of ALI following TACE in patients with HBV-related intermediate or advanced HCC. By integrating these variables, the proposed nomogram provides a practical tool for individualized risk assessment and may assist in perioperative management and treatment planning. External validation through multicenter prospective studies is warranted.
Core Tip: This study identifies Child-Pugh stage, number of transcatheter arterial chemoembolization (TACE), and hepatitis B virus (HBV) DNA load as independent risk factors for acute liver injury following TACE in patients with HBV-related intermediate to advanced hepatocellular carcinoma. We constructed a practical nomogram that integrates these variables, providing a validated tool for individualized preoperative risk stratification to optimize perioperative management and treatment planning for this specific population.
