What question did this study set out to answer?

The study aims to assess the risk of hepatotoxicity in HCC patients receiving TACE combined with other therapies and create a predictive nomogram.

March 26, 2026Open Access

Development and Validation of the TCAP Nomogram for Predicting Hepatotoxicity Risk in Hepatocellular Carcinoma Patients Receiving TACE Combined with Systemic Therapy

Puntos clave

The study aims to assess the risk of hepatotoxicity in HCC patients receiving TACE combined with other therapies and create a predictive nomogram.
Retrospective analysis of 200 HCC patients
Treatment groups included TACE plus tyrosine kinase inhibitors (TKIs) or TACE plus TKIs and immune checkpoint inhibitors (ICIs)
Hepatotoxicity was graded using CTCAE v5.0
Multivariate logistic regression was applied to identify independent predictors and develop the nomogram.
Overall hepatotoxicity incidence was 38.00%, mostly mild-to-moderate
Key independent predictors include liver cirrhosis, ALBI Grade 2/3, elevated total bilirubin, and decreased prothrombin activity
The TCAP nomogram showed an AUC of 0.855 with 82.00% sensitivity and 79.10% specificity.

Resumen

Background and Aims: The combination of transarterial chemoembolization (TACE) with molecular targeted therapy and/or immune checkpoint inhibitors (ICIs) has emerged as a cornerstone treatment for intermediate-to-advanced hepatocellular carcinoma (HCC). However, the risk of hepatotoxicity associated with these multimodal regimens remains inadequately characterized. This study aimed to evaluate the incidence, severity, and independent predictors of hepatotoxicity, and to develop a clinically practical prediction model. Materials and Methods: This retrospective study analyzed data from 200 HCC patients treated at Shandong First Medical University Affiliated Cancer Hospital between October 2021 and July 2024. Patients received either TACE plus tyrosine kinase inhibitors (TKIs) (n=120) or TACE plus TKIs and ICIs (n=80). Hepatotoxicity was graded according to CTCAE v5.0 criteria. Multivariate logistic regression was employed to identify independent risk factors and construct a predictive nomogram. Results: The overall hepatotoxicity incidence was 38.00%, predominantly mild-to-moderate (Grade 1: 63.16%; Grade 2: 23.68%; Grade 3: 13.16%). No Grade 4 events occurred, and no significant difference was observed between treatment groups (P=0.637). Multivariate analysis identified four independent predictors: liver cirrhosis (OR=1.684), ALBI Grade 2/3 (OR=6.436), elevated total bilirubin (OR=1.040), and decreased prothrombin activity (OR=0.968). The resulting TCAP (Total bilirubin, Cirrhosis, ALBI grade, Prothrombin activity) nomogram demonstrated robust discriminatory performance (AUC=0.855) with a sensitivity of 82.00% and specificity of 79.10% at the optimal cut-off value of 0.419. Conclusion: The TCAP nomogram provides a reliable, evidence-based tool for individualized hepatotoxicity risk stratification in HCC patients undergoing TACE-based combination therapy. Keywords: hepatocellular carcinoma, transarterial chemoembolization, tyrosine kinase inhibitors, immune checkpoint inhibitors, hepatotoxicity, nomogram

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