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World J Gastroenterol. Nov 21, 2026; 32(43): 122240
Published online Nov 21, 2026. doi: 10.3748/wjg.122240
Changes in liver and spleen stiffness after transarterial chemoembolization for hepatocellular carcinoma and role in predicting hepatic decompensation
Chidkamon Pattarawongpaiboon, Panarat Thaimai, Sangdao Boonkaya, Kanteera Sriyudthsak, Salisa Lertsanguansinchai, Prooksa Ananchuensook, Supachaya Sriphoosanaphan, Nutcha Pinjaroen, Sombat Treeprasertsuk, Piyawat Komolmit, Kessarin Thanapirom
Chidkamon Pattarawongpaiboon, Panarat Thaimai, Sangdao Boonkaya, Kanteera Sriyudthsak, Salisa Lertsanguansinchai, Prooksa Ananchuensook, Supachaya Sriphoosanaphan, Sombat Treeprasertsuk, Piyawat Komolmit, Kessarin Thanapirom, Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Krung Thep Maha Nakhon, Thailand
Prooksa Ananchuensook, Supachaya Sriphoosanaphan, Piyawat Komolmit, Kessarin Thanapirom, Center of Excellence in Liver Fibrosis and Cirrhosis, Chulalongkorn University, Bangkok 10330, Krung Thep Maha Nakhon, Thailand
Prooksa Ananchuensook, Supachaya Sriphoosanaphan, Piyawat Komolmit, Excellence Center in Liver Diseases, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Krung Thep Maha Nakhon, Thailand
Nutcha Pinjaroen, Department of Radiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Krung Thep Maha Nakhon, Thailand
Author contributions: Pattarawongpaiboon C, Komolmit P, and Thanapirom K were involved in the conception and design of the study; Pattarawongpaiboon C, Thaimai P, Boonkaya S, Sriyudthsak K, Lertsanguansinchai S, Ananchuensook P, Sriphoosanaphan S, and Pinjaroen N were involved in data curation and formal analysis; Thaimai P performed liver and splenic stiffness measurement; Pattarawongpaiboon C, Treeprasertsuk S, and Thanapirom K were involved in writing the original draft; all authors had access to the study data, reviewed and approved the final version of this manuscript.
AI contribution statement: No artificial intelligence (AI) tools or generative AI technologies were used in the research design, data analysis, drafting, or editing of this manuscript. The manuscript was written entirely by the authors, with language refinement provided solely by professional human editors. The authors take full responsibility for the originality, accuracy, and integrity of the content.
Supported by The Gastroenterological Association of Thailand (GAT).
Institutional review board statement: The study protocol was approved by the Institutional Review Board of the Faculty of Medicine, Chulalongkorn University (COA No. 1331/2024; IRB No. 0322/67), and was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines.
Clinical trial registration statement: The study protocol was registered in the Thai Clinical Trial Registry (No. TCTR20241021001) on October 21, 2024, prior to the official initiation of participant enrollment in November 2024.
Informed consent statement: Written informed consent was obtained from each participant.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding author at
kessarin.t@chula.ac.th. Participants gave informed consent for data sharing and the presented data are anonymized and risk of identification is low.
Corresponding author: Kessarin Thanapirom, MD, Associate Professor, Division of Gastroen
terology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Krung Thep Maha Nakhon, Thailand.
kessarin.t@chula.ac.th
Received: April 17, 2026
Revised: June 8, 2026
Accepted: June 25, 2026
Published online: November 21, 2026
Processing time: 161 Days and 8.1 Hours
BACKGROUND
Transarterial chemoembolization (TACE) alters hepatic perfusion and can potentially impact portal pressure in hepatocellular carcinoma (HCC) patients. Liver stiffness measurements (LSM) and spleen stiffness measurements (SSM) have emerged as promising tools for assessing portal hypertension. However, limited data exist regarding the effects of TACE on LSM and SSM. We hypothesized that TACE may influence short-term LSM and SSM and that baseline stiffness values can effectively identify patients at high risk for postprocedural hepatic decompensation.
AIM
To evaluate the short-term effects of TACE on stiffness measurements, and assess their baseline values for predicting 6-month hepatic decompensation.
METHODS
This prospective cohort study enrolled 102 HCC patients undergoing TACE. LSM and SSM measured by elastography at baseline, day 10, and day 30 post-procedure. A linear mixed-effects model was used to account for missing data with time as a fixed effect and participant identification as a random effect. Hepatic decompensation was defined as a composite endpoint of ascites, variceal bleeding, overt hepatic encephalopathy, and severe liver injury. Multiple logistic regression identified independent predictors of 6-month hepatic decompensation.
RESULTS
The linear mixed-effects model revealed no significant change in LSM and SSM values on days 10 and 30 after TACE compared to baseline. Within 6 months, 19 patients (18.6%) developed hepatic decompensation. Baseline SSM > 54 kilopascals (kPa) predicted hepatic decompensation with an area under the receiver operating characteristic curve of 0.83 [95% confidence interval (CI): 0.72-0.93], sensitivity of 63.2%, specificity of 90.4%. Multivariate analysis identified modified albumin-bilirubin (mALBI) grade ≥ 2B [adjusted odds ratio (aOR) = 7.05, 95%CI: 1.92-25.94, P = 0.003] and baseline SSM > 54 kPa (aOR = 16.52, 95%CI: 4.39-62.19, P < 0.001) as independent predictors of decompensation.
CONCLUSION
TACE does not significantly affect short-term stiffness measurements. However, baseline SSM can serve as an effective surrogate marker that complements the mALBI grade for stratifying hepatic decompensation risk.
Core Tip: This prospective study evaluated the changes in liver stiffness measurements (LSM) and spleen stiffness measurements (SSM) assessed by two-dimensional shear wave elastography and transient elastography in patients with hepatocellular carcinoma undergoing transarterial chemoembolization. Both LSM and SSM showed no significant changes on days 10 and days 30 after the procedure. Importantly, baseline SSM was identified as a significant non-invasive predictor of 6-month hepatic decompensation. Incorporating baseline SSM (> 54 kilopascals) alongside the modified albumin-bilirubin grade can serve as a comprehensive preprocedural risk stratification tool, effectively bridging the prognostic gap, particularly in clinically homogeneous patients with preserved liver function.
