Prognostic Significance of Lactate Dehydrogenase and C-Reactive Protein-to-Albumin Ratio in Hepatocellular Carcinoma Patients Treated with Transarterial Chemoembolization

doi:10.3877/cma.j.issn.2095-5782.2026.01.010

Abstract

Abstract:

Objective

To evaluate the predictive value of serum lactate dehydrogenase (LDH) levels and C-reactive protein to albumin ratio (CAR) for survival outcomes in hepatocellular carcinoma (HCC) patients undergoing transarterial chemoembolization (TACE).

Methods

A retrospective analysis was conducted on 148 HCC patients who received at least three TACE sessions between January 2017 and December 2024. According to the Modified Response Evaluation Criteria in Solid Tumors (mRECIST), patients were divided into the poor prognosis group (n=65) and the good prognosis group (n=83). Relevant indicators were analyzed using Kaplan-Meier method, Cox proportional hazards regression model and receiver operating characteristic curve.

Results

Kaplan-Meier analysis revealed that the median overall survival (OS) of patients in the poor prognosis group was 24 months, which was significantly shorter than 37 months in the good prognosis group (P<0.001). The median OS of the group with LDH≤250 U/L (34 months) was significantly better than that of the group with LDH>250 U/L (16 months; P<0.001). The median OS of the low-CAR group was significantly longer than that of the high-CAR group (P=0.004). Multivariate Cox regression analysis confirmed that Barcelona Clinic Liver Cancer (BCLC) stage, elevated LDH and elevated CAR were independent risk factors for shortened OS (all P<0.05).

Conclusion

Serum LDH and CAR levels can serve as effective prognostic predictors for HCC patients after TACE. These biomarkers are easy to detect and cost-effective, and have important clinical application value.

Key words: Hepatocellular carcinoma, Transarterial chemoembolization, Lactate dehydrogenase, C-reactive protein to albumin ratio

Tao Lu, Hao Li, Diwen Zhu, Yingjun Bao, Yifan Li, Junpeng Gu, Weixin Ren. Prognostic Significance of Lactate Dehydrogenase and C-Reactive Protein-to-Albumin Ratio in Hepatocellular Carcinoma Patients Treated with Transarterial Chemoembolization[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2026, 14(01): 66-71.

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Figures/Tables 6

一般临床资料	TACE预后不良组(n=65)	TACE预后良好组(n=83)	P值
年龄(岁， $x ¯$ ±s)	57.70±11.10	58.30±11.10	0.989
性别[例(%)]			0.628
男	53(35.80)	65(43.90)
女	12(8.10)	18(12.20)
乙型肝炎病毒[例(%)]			0.190
有	53(37.20)	76(51.40)
无	10(6.80)	7(4.70)
肝硬化[例(%)]			0.977
有	44(29.70)	56(37.80)
无	21(14.20)	27(18.20)
腹水[例(%)]			0.672
有	13(8.80)	19(12.80)
无	52(35.10)	64(43.20)
肿瘤最大径[cm, M(Q₁，Q₃)]	4.90(3.10, 8.30)	5.97(3.50, 9.20)	0.471
肿瘤数目[例(%)]			0.322
1	25(16.80)	38(25.60)
2	9(6.10)	12(8.10)
≥3	31(21.10)	33(22.30)
肿瘤边界[例(%)]			0.709
类圆形	46(31.10)	61(41.20)
不规则形	19(12.80)	22(14.90)
门脉癌栓[例(%)]			0.057
有	26(17.70)	21(14.20)
无	39(26.40)	61(41.20)
肿瘤分布[例(%)]			0.703
单叶分布	45(30.40)	55(37.20)
双叶分布	20(13.50)	28(18.90)
BCLC分期[例(%)]			0.149
A	19(12.80)	36(24.30)
B	22(14.90)	30(20.30)
C	24(16.30)	20(13.50)
TBIL[μmol/L，M(Q₁，Q₃)]	17.10(14.10, 22.20)	18.03(13.90, 26.20)	0.399
CAR[M(Q₁，Q₃)]	0.20(0.10, 0.40)	0.20(0.07, 0.30)	0.028
ALT[U/L，M(Q₁，Q₃)]	45.90(26.60, 72.30)	38.10(26, 58)	0.144
AST[U/L，M(Q₁，Q₃)]	50.40(30.10, 68.70)	50(33, 82.20)	0.489
AFP[ng/mL，M(Q₁，Q₃)]	63.90(5.02, 699.30)	52.60(7.05, 726.50)	0.679
LDH[U/L，M(Q₁，Q₃)]	188.70(157.10, 224.00)	208(173.50, 267.40)	0.015

一般临床资料	TACE预后不良组(n=65)	TACE预后良好组(n=83)	P值
年龄(岁， $x ¯$ ±s)	57.70±11.10	58.30±11.10	0.989
性别[例(%)]			0.628
男	53(35.80)	65(43.90)
女	12(8.10)	18(12.20)
乙型肝炎病毒[例(%)]			0.190
有	53(37.20)	76(51.40)
无	10(6.80)	7(4.70)
肝硬化[例(%)]			0.977
有	44(29.70)	56(37.80)
无	21(14.20)	27(18.20)
腹水[例(%)]			0.672
有	13(8.80)	19(12.80)
无	52(35.10)	64(43.20)
肿瘤最大径[cm, M(Q₁，Q₃)]	4.90(3.10, 8.30)	5.97(3.50, 9.20)	0.471
肿瘤数目[例(%)]			0.322
1	25(16.80)	38(25.60)
2	9(6.10)	12(8.10)
≥3	31(21.10)	33(22.30)
肿瘤边界[例(%)]			0.709
类圆形	46(31.10)	61(41.20)
不规则形	19(12.80)	22(14.90)
门脉癌栓[例(%)]			0.057
有	26(17.70)	21(14.20)
无	39(26.40)	61(41.20)
肿瘤分布[例(%)]			0.703
单叶分布	45(30.40)	55(37.20)
双叶分布	20(13.50)	28(18.90)
BCLC分期[例(%)]			0.149
A	19(12.80)	36(24.30)
B	22(14.90)	30(20.30)
C	24(16.30)	20(13.50)
TBIL[μmol/L，M(Q₁，Q₃)]	17.10(14.10, 22.20)	18.03(13.90, 26.20)	0.399
CAR[M(Q₁，Q₃)]	0.20(0.10, 0.40)	0.20(0.07, 0.30)	0.028
ALT[U/L，M(Q₁，Q₃)]	45.90(26.60, 72.30)	38.10(26, 58)	0.144
AST[U/L，M(Q₁，Q₃)]	50.40(30.10, 68.70)	50(33, 82.20)	0.489
AFP[ng/mL，M(Q₁，Q₃)]	63.90(5.02, 699.30)	52.60(7.05, 726.50)	0.679
LDH[U/L，M(Q₁，Q₃)]	188.70(157.10, 224.00)	208(173.50, 267.40)	0.015

项目	单因素分析			多因素分析
项目	HR	95% CI	P值	HR	95% CI	P值
乙肝	0.913	0.389~2.143	0.834
肝硬化	0.811	0.474~1.386	0.443
腹水	0.845	0.538~2.132	0.845
肿瘤最大径	1.052	0.977~1.133	0.182
肿瘤数目	1.325	0.981~1.790	0.066
肿瘤边界	0.397	0.215~0.734	0.003	0.565	0.277-1.156	0.118
门脉癌栓	2.509	1.391~4.523	0.002	1.148	0.518-2.544	0.734
肿瘤分布	1.374	0.789~2.393	0.262
BCLC分期	2.164	1.489~3.146	<0.001	1.718	1.057-2.793	0.029
AFP	1.000	1.000~1.001	0.342
LDH	1.006	1.003~1.010	<0.001	1.004	1.000-1.008	0.027
CAR	4.618	2.012~10.599	<0.001	4.407	1.791-10.845	0.001
ALT	1.000	0.995~1.006	0.855
AST	1.003	0.999~1.007	0.097
Tbil	1.014	0.995~1.032	0.149

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