Predicting severe liver dysfunction following locoregional therapy for early- and intermediate-stage hepatocellular carcinoma.

Predicting short-term liver dysfunction after locoregional therapy (LRT) for hepatocellular carcinoma (HCC) remains challenging, and the relative prognostic value of liver function, tumor diameter, and patient characteristics is not well defined. Improved risk stratification may inform patient selection and peri-procedural decision-making. We performed a retrospective cohort study of patients with HCC undergoing LRT in the Veterans Health Administration. Clinical, laboratory, and tumor-related variables were evaluated for their ability to predict 30-day and 90-day outcomes of liver dysfunction. Model discrimination was assessed in the test dataset using the area under the receiver operating characteristic curve (AUC) with 95% confidence intervals, and calibration was evaluated using calibration plots and Brier scores. Among 1183 patients with early- to intermediate-stage HCC, liver function-based scores consistently showed the strongest predictive performance. For 30-day outcomes, the Model for End-stage Liver Disease (MELD) score demonstrated the highest discrimination, followed by MELD-Na and serum bilirubin. Similar patterns were observed for 90-day outcomes. In contrast, total tumor diameter measures and demographic variables exhibited limited discriminatory ability. Overall model calibration was acceptable across risk strata. In patients undergoing LRT for HCC, measures of liver function outperform tumor-related and demographic variables in predicting liver failure. These findings underscore the central role of hepatic reserve in peri-procedural risk assessment and support prioritizing liver severity metrics when evaluating candidates for LRT.