Evaluation of the prognostic value of the LiMAx test in patients with hepatocellular carcinoma treated with transarterial chemoembolization

Introduction The LiMAx (liver maximum capacity) breath test is a dynamic tool for accurate assessment of hepatic function.

Objectives To evaluate the association between baseline and longitudinal LiMAx readouts and survival in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE).

Method In total, 30 HCC patients were prospectively recruited at our tertiary care center. 25 were included in the baseline and 20 in longitudinal analysis. LiMAx test and blood sampling were conducted prior to the first and second TACE. Patients were followed for a minimum of one year. The prognostic value of baseline and longitudinal LiMAx values was assessed using (extended) univariable Cox models, Kaplan-Meier and receiver operating characteristic (ROC) curve analysis.

Results 21 (84.0%) were male and 23 (92.0%) had BCLC stage B. Most had alcohol-related liver cirrhosis (n= 15, 60%) and no prior HCC treatment (n= 19, 76.0%). Median baseline LiMAx value was 261 µg/kg/h (interquartile range (IQR) 159-387). Extended univariable Cox regression analysis showed that LiMAx, ALBI, Child-Pugh and MELD score were associated with overall survival (OS; LiMAx standardized: hazard ratio (HR) 0.297, 95% CI 0.111 – 0.796, p= 0.016; ALBI score standardized: HR 4.051, 95% CI 1.813 – 9.052, p= 0.001; Child-Pugh score standardized: HR 2.616, 95% CI 1.450 – 4.719, p= 0.001; MELD standardized: HR 2.781, 95% CI 1.356 – 5.703, p= 0.005). Using a threshold of 261 µg/kg/h at baseline, LiMAx was significantly associated with outcome (median OS LiMAx≥261 µg/kg/h: 15.25 months (IQR 11.03 – 24.03), LiMAx< 261 µg/kg/h: 8.55 months (IQR 3.41 – 13.75), Log-Rank p= 0.009). In terms of predicting 90-day mortality after the second LiMAx test, the percent change in LiMAx values had an area under the ROC curve (AUROC) of 1.000 (p=0.007).

Conclusion LiMAx readouts predict prognosis of TACE-treated HCC patients. The percent change in LiMAx value predicts 90-day mortality and may help to select patients who will not benefit from continued TACE.

Publication History

Article published online:
19 August 2022