Post-embolisation syndrome trajectories and predictors in patients with hepatocellular carcinoma undergoing transarterial chemoembolisation: A retrospective study.

[PURPOSE] Although post-embolisation syndrome (PES) is a well-known adverse effect, little is known about its trajectory across repeated transarterial chemoembolization (TACE) sessions. This study aimed to examine longitudinal changes in PES occurrence across repeated TACE sessions and to explore whether the predictors of PES vary depending on the treatment session.

[METHODS] This study comprised a retrospective review of 1491 records of TACE from a single tertiary hospital. Clinical data including tumour characteristics, procedural details, and laboratory parameters were extracted. Descriptive statistics, chi-square tests, analysis of variance (ANOVA) with Scheffé post-hoc tests, and Pearson correlations analyses were performed. A generalised linear mixed model with random intercepts was applied and sensitivity analyses were conducted to test the robustness of the model.

[RESULTS] PES occurrence remained stable up to the eighth session but showed greater variability and a resurgence in frequency after the 14th TACE. Elevated post-TACE alanine aminotransferase (ALT) levels were consistently associated with increased odds of PES across all treatment phases, with a five-fold higher risk observed after the 14th session (OR = 5.17, p = .27). Overall, liver enzyme and immune-inflammatory markers such as ALT and C-reactive protein (CRP)-to-lymphocyte ratio were the primary determinants influencing PES trajectory.

[CONCLUSIONS] This study identified the longitudinal trajectory and predictors of PES across repeated TACE sessions, showing increased incidence after the 14th session and consistent associations with hepatic and immune-inflammatory markers. These findings highlight the need for phase-specific, nurse-led monitoring and hepatoprotective care to manage evolving PES risks throughout the TACE trajectory.