Higher indocyanine green retention rates predicted improved prognoses in hepatocellular carcinoma patients treated with transcatheter arterial chemoembolization

Abstract

Progression of liver fibrosis causes portal hypertension with thrombocytopenia, and intrahepatic hypoperfusion with mesenchymal dysfunction evaluated by the indocyanine green retention rate at 15 minutes (ICG-R15), in which the serum levels of indocyanine green are measured 15 minutes after bullous injection. Thrombocytopenia caused by portal hypertension has been associated with improved prognosis in hepatocellular carcinoma (HCC) patients treated using transcatheter arterial chemoembolization therapy (TACE). However, the clinical significance of higher ICG-R15 in HCC patients treated with nonsurgical therapies is poorly established. This study aimed to clarify the correlation between ICG-R15 and prognosis of HCC in patients treated with TACE. Briefly, we included HCC patients treated with TACE after ICG-R15. Cox proportional hazard model analysis was performed to identify independent prognostic factors. After adjusting for age, sex, stage of hepatocellular carcinoma, albumin bilirubin score, etiologies, and baseline year by propensity score matching, the prognostic impact of higher ICG-R15 was evaluated using the Kaplan–Meier curve. As results, 278 patients were included in this study. Univariate and multivariate analyses identified higher ICG-R15 and lower platelet count as positive prognostic factors for overall survival. Propensity score matching generated two 77-patient cohorts, ICG-R15<20% group and ICG-R15>20% one. The overall survival of the ICG-R15>20% group was significantly better than that of ICG-R15<20%. In conclusions, higher ICG-R15 in addition to lower platelet count acted as positive long-term prognostic factors in HCC patients treated with TACE.