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Wang X, Wang J, Li J, Liang K, Dai S, Wang R, Zhang Y, Ren Q, Meng L, Qiu Y. Effect of skeletal muscle index on post-embolization syndrome of hepatocellular carcinoma after transarterial chemoembolization. BMC Gastroenterol 2024; 24:333. [PMID: 39350028 PMCID: PMC11441167 DOI: 10.1186/s12876-024-03427-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 09/20/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Skeletal muscle index (SMI) is a commonly used research method for evaluating muscle mass.However, its impact on post-embolization syndrome(PES) of patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE) is unclear.Our objective was to determine the effect of SMI on PES after TACE in patients with HCC. METHODS We conducted a retrospective analysis of patients who received TACE treatment for HCC at our hospital from 2015 to 2020. The subjects were divided into two groups according to the presence or absence of PES after TACE, and their clinical characteristics were compared.SMI was measured and calculated by cross-sectionally at the level of the third lumbar vertebra based on computed tomography (CT). According to the cutoff value, the patients were classified into either low or high SMI group.Potential risk factors for PES were assessed using univariate and multivariable Cox proportional risk models. RESULTS A total of 110 people were included in this study, from which including 82 patients experienced PES. Serum albumin was significantly lower in the PES group compared to the non-PES group.The frequency of HCC with a maximum diameter > 3 cm and low SMI in the PES group was significantly higher than in patients without PES. Cox multivariate analysis identified that the maximum diameter of HCC > 3 cm and low SMI were independent predictors of PES after TACE. CONCLUSIONS Low SMI is an independent predictor of PES in HCC patients after TACE treatment, making preoperative CT assessment of skeletal muscle mass is a simple and effective tool for predicting PES.
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Affiliation(s)
- Xiaojuan Wang
- Hebei Provincial Key Laboratory of Portal Hypertension and Cirrhosis, Xingtai People's Hospital, Xingtai, Hebei, 054001, China
| | - Jitao Wang
- Hebei Provincial Key Laboratory of Portal Hypertension and Cirrhosis, Xingtai People's Hospital, Xingtai, Hebei, 054001, China.
- Hepatopancreatobiliary Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| | - Jinlong Li
- Hebei Provincial Key Laboratory of Portal Hypertension and Cirrhosis, Xingtai People's Hospital, Xingtai, Hebei, 054001, China
| | - Kuopeng Liang
- Hebei Provincial Key Laboratory of Portal Hypertension and Cirrhosis, Xingtai People's Hospital, Xingtai, Hebei, 054001, China
| | - Shoufang Dai
- Hebei Provincial Key Laboratory of Portal Hypertension and Cirrhosis, Xingtai People's Hospital, Xingtai, Hebei, 054001, China
| | - Ruikun Wang
- Hebei Medical University, Shijiazhuang, Hebei, 050017, China
| | - Yi Zhang
- Hebei Medical University, Shijiazhuang, Hebei, 050017, China
| | - Quan Ren
- Chengde Medical College, Chengde, Hebei, 067000, China
| | - Linglei Meng
- Hebei Provincial Key Laboratory of Portal Hypertension and Cirrhosis, Xingtai People's Hospital, Xingtai, Hebei, 054001, China
| | - Yuzi Qiu
- Hebei Provincial Key Laboratory of Portal Hypertension and Cirrhosis, Xingtai People's Hospital, Xingtai, Hebei, 054001, China
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Chang X, Li X, Sun P, Li Z, Sun P, Ning S. HAIC Combined with lenvatinib plus PD-1 versus lenvatinib Plus PD-1 in patients with high-risk advanced HCC: a real-world study. BMC Cancer 2024; 24:480. [PMID: 38627684 PMCID: PMC11020267 DOI: 10.1186/s12885-024-12233-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 04/08/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND The treatment of hepatocellular carcinoma (HCC) patients exhibiting high-risk characteristics (Vp4, and/or bile duct invasion, and/or tumor occupancy ≥ 50%) lacks standardized approaches and yields unfavorable results. This study endeavors to evaluate the safety, efficacy, and prognostic impacts of employing hepatic arterial infusion chemotherapy (HAIC), lenvatinib, and humanized programmed death receptor-1 (PD-1) in the treatment of high-risk HCC patients. METHODS In this retrospective analysis, HCC patients with high-risk features were treated with either lenvatinib combined with PD-1 (LEN-PD1) or a combination of HAIC, lenvatinib, and PD-1 (HAIC-LEN-PD1). The study assessed the antitumor efficacy by calculating overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and disease control rate (DCR). Treatment-related adverse events (TRAEs) were analyzed to assess the safety profiles. RESULTS Between June 2019 and September 2022, a total of 61 patients were included in the LEN-PD1 group, while 103 patients were enrolled in the HAIC-LEN-PD1 group. The OS was 9.8 months in the LEN-PD1 group, whereas the HAIC-LEN-PD1 group exhibited a significantly longer median OS of 19.3 months (HR = 0.43, p < 0.001). Furthermore, PFS was notably extended in the HAIC-LEN-PD1 group compared to the LEN-PD1 group (9.6 months vs. 4.9 months, HR = 0.48, p < 0.001). Patients in the HAIC-LEN-PD1 group had a higher ORR and DCR according to the modified RECIST (76.7% vs. 23.0%, p < 0.001; 92.2% vs. 72.1%, p = 0.001). HAIC-LEN-HAIC group led to more adverse events than LEN-PD1 group, most of which were tolerable and controllable. CONCLUSION Lenvatinib, HAIC and PD-1 showed safe and promising anti-tumor activity compared with lenvatinib alone for HCC with high-risk features.
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Affiliation(s)
- Xu Chang
- Department of Interventional Therapy II, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Xinge Li
- Department of Oncology, Central Hospital Affiliated to Shandong First Medical University, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Peng Sun
- Department of Interventional Therapy II, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Zhenfeng Li
- Department of Interventional Therapy II, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, Jinan, Shandong, China
| | - Pengfei Sun
- Department of Hepatological Surgery, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, 250117, Jinan, Shandong, China.
| | - Shangkun Ning
- Department of Interventional Therapy I, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences, 250117, Jinan, Shandong, China.
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Bai J, Huang M, Zhou J, Song B, Hua J, Ding R. Development of a predictive nomogram for postembolization syndrome after transcatheter arterial chemoembolization of hepatocellular carcinoma. Sci Rep 2024; 14:3303. [PMID: 38332011 PMCID: PMC10853204 DOI: 10.1038/s41598-024-53711-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/04/2024] [Indexed: 02/10/2024] Open
Abstract
Post-embolization syndrome (PES) is a frequent complication after receiving transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC), but only a few studies have focused on the factors influencing PES in those patients. In this study, the impact factors of PES were explored and a nomogram was constructed to predict the occurrence of PES in HCC patients with TACE. This was a retrospective cohort study of HCC patients who underwent TACE obtained from the third affiliated Hospital of Kunming Medical University between January 1, 2020, and September 1, 2022. T‑test and Chi‑square test were used to search for factors influencing PES occurrence, and then the nomogram was further established based on multivariable logistic regression analysis. Validation of the predictive nomogram was also evaluated by calibration curve, concordance index (C-index), and receiver operating characteristic (ROC) curves. The enrolled patients (n = 258) were randomly assigned to the primary cohort (n = 180) and validation cohort (n = 78) in a 7:3 ratio. Among 180 patients in the primary cohort, 106 (58.89%) experienced PES. TACE types (P = 0.015), embolization degree (P = 0.008), and tumor number (P = 0.026) were identified as predictors by the logistic regression analysis and were used to develop the predictive nomogram. The internally validated and externally validated C-indexes were 0.713 and 0.703, respectively. The calibration curves presented good consistency between actual and predictive survival. Types of embolic agents, embolization degree, and tumor number were found to be the predictors of PES after TACE. The nomogram could reliably predict PES in HCC patients with TACE. This predictive model might be considered for clinical practice.
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Affiliation(s)
- Jinfeng Bai
- Minimally Invasive Intervention Department, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - Ming Huang
- Minimally Invasive Intervention Department, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - Jinmei Zhou
- Minimally Invasive Intervention Department, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - Bohan Song
- Minimally Invasive Intervention Department, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - Jianjie Hua
- Minimally Invasive Intervention Department, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China
| | - Rong Ding
- Minimally Invasive Intervention Department, The Third Affiliated Hospital of Kunming Medical University, Kunming, 650118, China.
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Yao Y, Huang X, Zhao C, Wang X, Mi G, Liu J. Summary of the evidence of best practices for the prevention and treatment of embolism syndrome after TACE in primary liver cancer. Front Oncol 2024; 13:1274235. [PMID: 38288104 PMCID: PMC10824559 DOI: 10.3389/fonc.2023.1274235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/14/2023] [Indexed: 01/31/2024] Open
Abstract
Objective This study aims to retrieve, evaluate, and summarize domestic and foreign evidence on the prevention and treatment of embolism syndrome following transcatheter arterial chemoembolization (TACE) for primary liver cancer and to provide an evidence-based foundation for clinical practice. Methods Utilizing the "6S" model, we conducted a systematic search of UpToDate, BMJ Best Practice, domestic and foreign guidelines, and related databases on the prevention and treatment of embolism syndrome following TACE for primary liver cancer. This search included clinical decision-making, guidelines, systematic reviews, evidence summaries, randomized controlled trials, and expert consensus. The search time frame extended from January 1, 2013 to May 1, 2023. Evidence was synthesized after an independent review of the included studies by two investigators. Results A total of 11 articles were included in the analysis, comprising one clinical decision-making article, three clinical guidelines, six expert consensus articles, and one randomized controlled trial. We summarized 31 pieces of evidence across three categories: preoperative preparation, intraoperative interventions, and postoperative symptom management. Conclusion This study presents a comprehensive summary of the best available evidence on the prevention and treatment of embolism syndrome following TACE for primary liver cancer. These findings can serve as a valuable reference for clinical practitioners, enabling nurses to deliver individualized care based on the symptoms and specific needs of liver cancer patients. Systematic review registration http://ebn.nursing.fudan.edu.cn, identifier ES20232398.
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Affiliation(s)
- Yanrong Yao
- Department of Hepatobilology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Xi Huang
- School of Nursing, Shanxi University of Chinese Medicine, Xianyang, China
| | - Chengsi Zhao
- Department of Hepatobilology, General Hospital of Ningxia Medical University, Yinchuan, China
| | - XiaoYan Wang
- Department of Neonatal Intensive Care Unit, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Guangli Mi
- School of Nursing, Ningxia Medical University, Yinchuan, China
| | - Jingli Liu
- Department of Hepatobilology, General Hospital of Ningxia Medical University, Yinchuan, China
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Qin H, Xiao X, Ya H, Li J, Liang F, Jin H, Liao L, Li Y, Qin J, Yu J, Gu J, Zhou C, Jin M, Miao Y, Li S. Nomogram for predicting severe abdominal pain after initial conventional transarterial chemoembolisation for hepatocellular carcinoma: a retrospective study. Sci Rep 2023; 13:22397. [PMID: 38104191 PMCID: PMC10725474 DOI: 10.1038/s41598-023-49509-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/08/2023] [Indexed: 12/19/2023] Open
Abstract
Transarterial chemoembolisation (TACE) is a standard therapy for hepatocellular carcinoma (HCC). However, adverse events, including abdominal pain, are common. This study aimed to investigate and verify the feasibility of a nomogram model to predict severe abdominal pain after first conventional TACE (cTACE) among patients with HCC. Patients with HCC treated with cTACE between October 28, 2019, and August 5, 2022, at a single centre were enrolled (n = 216). Patients were divided into training and validation cohorts (ratio, 7:3). A visual analogue scale score between 7 and 10 was considered severe abdominal pain. A total of 127 (58.8%) patients complained of severe abdominal pain after first cTACE treatment. The nomogram considered age and tumour number and size. The nomogram demonstrated good discrimination, with a C-index of 0.749 (95% confidence interval [CI], 0.617, 0.881). Further, the C-index in the validation cohort reached 0.728 (95% CI 0.592, 0.864). The calibration curves showed ideal agreement between the prediction and real observations, and the nomogram decision curve analysis performed well. The nomogram model can provide an accurate prediction of severe abdominal pain in patients with HCC after first cTACE, aiding in the personalization of pain management and providing novel insights into hospital nursing.
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Affiliation(s)
- Huixia Qin
- Department of Interventional Radiology Center, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Xuhua Xiao
- Department of Gastroenterology, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Houxiang Ya
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Jinhai Li
- Department of Liver and Gall Surgery, The Third Affiliated Hospital of Wenzhou Medical University, Zhejiang, China
| | - Fugang Liang
- Department of Interventional Radiology Center, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Haiqing Jin
- Department of Interventional Radiology Center, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Lianghuan Liao
- Department of Interventional Radiology Center, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Yaohua Li
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Jiahui Qin
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Jue Yu
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Jing Gu
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Chunmei Zhou
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Ming Jin
- Department of Vascular Intervention, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Ying Miao
- Department of Vascular Intervention, Affiliated Hospital of Guilin Medical University, Guilin, China
| | - Shuqun Li
- Department of Hepatobiliary and Pancreatic Surgery, Affiliated Hospital of Guilin Medical University, Guilin, China.
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Lu H, Zheng C, Liang B, Xia X. Efficacy and safety analysis of dexamethasone + palonosetron in prevention of post-embolization syndrome after D-TACE: A retrospective study. Medicine (Baltimore) 2023; 102:e35433. [PMID: 37800841 PMCID: PMC10553024 DOI: 10.1097/md.0000000000035433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/01/2023] [Indexed: 10/07/2023] Open
Abstract
To investigate the efficacy and safety of dexamethasone + palonosetron in the prevention of post-embolization syndrome after drug-eluting beads transcatheter arterial chemoembolization (D-TACE). The data of 278 patients who received D-TACE from January 2018 to December 2021 were collected and divided into 2 groups: D-TACE group (N = 145) and D-TACE + dexamethasone + palonosetron group (N = 133). The incidence of post-embolization syndrome and infection after D-TACE was assessed in both groups. Incidence of abdominal pain: D-TACE group versus D-TACE + dexamethasone + palonosetron group, 56.6% versus 40.6%, P = .008; incidence of fever: D-TACE group versus D-TACE + dexamethasone + palonosetron group, 40.0% versus 14.3%, P = .000; incidence of nausea: D-TACE group versus D-TACE + dexamethasone + palonosetron group, 61.4% versus 39.8%, P = .001; incidence of vomiting: D-TACE group versus D-TACE + dexamethasone + palonosetron group, 48.3% versus 21.1%, P = .000; incidence of infection: D-TACE group versus D-TACE + dexamethasone + palonosetron group, 1.4% versus 1.5%, P = .931. The combined use of dexamethasone and palonosetron before D-TACE can effectively reduce the incidence of post-embolization syndrome and reduce the degree of side effects, but it will not increase the risk of infection.
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Affiliation(s)
- Haohao Lu
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chuansheng Zheng
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Bin Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xiangwen Xia
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Roehlen N, Stoehr F, Müller L, Luxenburger H, Gairing SJ, Reincke M, Schultheiss M, Berisha F, Weinmann A, Foerster F, Marquardt JU, Thimme R, Galle PR, Bettinger D, Kloeckner R. Prediction of postembolization syndrome after transarterial chemoembolization of hepatocellular carcinoma and its impact on prognosis. Hepatol Commun 2023; 7:e0252. [PMID: 37756031 PMCID: PMC10531352 DOI: 10.1097/hc9.0000000000000252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 07/15/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Postembolization syndrome (PES) represents the most frequent complication after transarterial chemoembolization (TACE) in patients with HCC. Given the vague definition as a symptom complex comprising abdominal pain, fever, and nausea, PES is diagnosed in heterogeneous patient cohorts with symptoms ranging from mild pain to severe deterioration of their general condition. This study aimed to evaluate predictive factors and the prognostic impact of PES with regard to different severity grades. METHODS A total of 954 patients treated with TACE for HCC at the University Medical Centres Mainz and Freiburg were included in this study. PES disease severity was graded as mild, moderate, or severe according to a predefined combination of symptoms. Logistic regression models were used to identify independent predictors of PES. The prognostic impact of PES was evaluated by competing risk analyses considering liver transplantation as a competing risk. RESULTS PES occurred in 616 patients (64.5%), but only 56 patients (5.9%) had severe PES, defined as moderate to severe abdominal pain requiring opioids in combination with fever and nausea. The largest tumor diameter was the strongest independent predictor of PES (OR = 1.21, 95% CI = 1.13-1.28), and severe PES (OR = 1.23, 95% CI = 1.14-1.33, p < 0.0001). Presence of liver cirrhosis was protective against PES (OR = 0.48, 95% CI = 0.27-0.84, p = 0.01). Furthermore, PES was independently associated with an impaired disease control rate (OR = 0.33, 95% CI = 0.16-0.69, p = 0.003) and severe PES with poor overall survival (subdistribution HR = 1.53, 95% CI = 0.99-2.36, p = 0.04). CONCLUSIONS Tumor size and absence of liver cirrhosis are predictors of severe PES and associated with impaired prognosis in HCC patients after TACE.
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Affiliation(s)
- Natascha Roehlen
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Stoehr
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Lukas Müller
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Hendrik Luxenburger
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon J. Gairing
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Marlene Reincke
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Schultheiss
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Floriona Berisha
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
| | - Arndt Weinmann
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Friedrich Foerster
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jens U. Marquardt
- Department of Medicine I, University Center Schleswig-Holstein-Campus Lübeck, Lübeck, Germany
| | - Robert Thimme
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter R. Galle
- Department of Internal Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Dominik Bettinger
- Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany
- Department of Diagnostic and Interventional Radiology, University of Lübeck, Lübeck, Germany
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Du QQ, Liang M, Jiang B, Zhang M, Yu XL, Li X, Hao JH. Incidence and predictors of abdominal pain after transarterial chemoembolization of hepatocellular carcinoma: a single-center retrospective study. Eur J Oncol Nurs 2023; 66:102355. [PMID: 37524027 DOI: 10.1016/j.ejon.2023.102355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/22/2023] [Accepted: 06/05/2023] [Indexed: 08/02/2023]
Abstract
PURPOSE To assess the incidence and predictive factors of abdominal pain following transarterial hepatic chemoembolization (TACE) in patients with hepatocellular carcinoma. METHODS In this single-center retrospective cohort study, abdominal pain was defined as a score of 4 or more within 72 h after TACE and requiring additional drug intervention. Patient, tumor characteristics, and technical factors associated with severe pain were identified using the decision tree and binary logistic regression model. RESULTS Of 220 patients who were included in the study, 126 (57.3%) had abdominal pain after 206 of 420 TACE procedures (49.0%). A predictive model built based on the logistic regression identified the drug-eluting bead TACE (DEB-TACE) (odds ratio [OR] = 3.340; 95% confidence interval [CI] 2.169-5.141), the number of tumors (OR = 2.235; 95% CI 1.060-4.713), embolization of both hepatic lobes (OR = 2.310; 95% CI 1.109-4.813), and concomitant extrahepatic artery embolism (OR = 2.654; 95% CI 1.227-5.739) as the independent predictors of severe abdominal pain. Similarly, the decision tree confirmed the DEB-TACE as the strongest predictor of subsequent performance, followed by the history of hepatectomy and the embolization in the right or both lobes. The area under the receiver operating characteristic curve (AUC) of the classification prediction effect of the two models was 0.706 for the logistic regression and 0.676 for the decision tree. Internal validation results show that the accuracy of logistic regression model prediction was 71.4%. CONCLUSION The model suggests that DEB-TACE and multiple treatment sites are predictors of abdominal pain after TACE in patients with hepatocellular carcinoma. It may help improve nursing management practices.
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Affiliation(s)
- Qian-Qian Du
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China; Department of Interventional Therapy, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, 230601, Anhui, China
| | - Min Liang
- Department of Interventional Therapy, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, 230601, Anhui, China
| | - Bo Jiang
- Department of Interventional Therapy, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, 230601, Anhui, China
| | - Miao Zhang
- Nursing Department, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, 230601, Anhui, China
| | - Xiao-Ling Yu
- Nursing Department, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, 230601, Anhui, China
| | - Xiao Li
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, No. 678 Furong Road, Hefei, 230601, Anhui, China
| | - Jia-Hu Hao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China.
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Thanakunchai T, Hongthanakorn C. Prevalence and Risk Factors of Post-chemoembolization Syndrome After Chemo-Embolization for Hepatocellular Carcinoma in Thailand. Dig Dis Sci 2023; 68:3818-3823. [PMID: 37402085 DOI: 10.1007/s10620-023-08010-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND The data regarding the incidence of post-embolization syndrome after transarterial chemoembolization for hepatocellular carcinoma in Thailand are scarce. Therefore, this study aimed to determine the prevalence and predictors of post-embolization syndrome after transarterial chemoembolization for hepatocellular carcinoma in Thailand. METHODS This retrospective study collected data from patients undergoing transarterial chemoembolization for five years. Post-embolization syndrome was defined as fever and/or abdominal pain, and/or nausea or vomiting that occurred within three days after the transarterial chemoembolization procedure for hepatocellular carcinoma or hospital discharge. Pre-defined predictors for post-embolization syndrome were explored using Poisson regression analysis. RESULTS Of the 298 patients and 739 transarterial chemoembolization procedures, the incidence of post-embolization syndrome was 68.1% (203/298) and the incidence density was 53.9% (398/739). Tumor size, Barcelona Clinic Liver Cancer stages, and dose of chemotherapy showed no association with the occurrence of PES. However, a model for end-stage liver disease score was the only predictor for post-embolization syndrome [adjusted IRR 0.91 (0.84-0.98); p = 0.01]. There were three patients developing fever after transarterial chemoembolization due to infection. CONCLUSION Post-embolization syndrome was common in patients undergoing transarterial chemoembolization for hepatocellular carcinoma. Patients with a lower model for end-stage liver disease scores were at increased risk of post-embolization syndrome. This study highlights the burden of post-embolization syndrome among patients with hepatocellular carcinoma receiving transarterial chemoembolization.
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Affiliation(s)
- Thanabadee Thanakunchai
- Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand
| | - Chanunta Hongthanakorn
- Gastroenterology Unit, Department of Medicine, Bhumibol Adulyadej Hospital, Royal Thai Air Force, Bangkok, Thailand.
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10
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Dhiman P, Ma J, Andaur Navarro CL, Speich B, Bullock G, Damen JAA, Hooft L, Kirtley S, Riley RD, Van Calster B, Moons KGM, Collins GS. Overinterpretation of findings in machine learning prediction model studies in oncology: a systematic review. J Clin Epidemiol 2023; 157:120-133. [PMID: 36935090 DOI: 10.1016/j.jclinepi.2023.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVES In biomedical research, spin is the overinterpretation of findings, and it is a growing concern. To date, the presence of spin has not been evaluated in prognostic model research in oncology, including studies developing and validating models for individualized risk prediction. STUDY DESIGN AND SETTING We conducted a systematic review, searching MEDLINE and EMBASE for oncology-related studies that developed and validated a prognostic model using machine learning published between 1st January, 2019, and 5th September, 2019. We used existing spin frameworks and described areas of highly suggestive spin practices. RESULTS We included 62 publications (including 152 developed models; 37 validated models). Reporting was inconsistent between methods and the results in 27% of studies due to additional analysis and selective reporting. Thirty-two studies (out of 36 applicable studies) reported comparisons between developed models in their discussion and predominantly used discrimination measures to support their claims (78%). Thirty-five studies (56%) used an overly strong or leading word in their title, abstract, results, discussion, or conclusion. CONCLUSION The potential for spin needs to be considered when reading, interpreting, and using studies that developed and validated prognostic models in oncology. Researchers should carefully report their prognostic model research using words that reflect their actual results and strength of evidence.
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Affiliation(s)
- Paula Dhiman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Jie Ma
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
| | - Constanza L Andaur Navarro
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Benjamin Speich
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK; Meta-Research Centre, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Garrett Bullock
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Johanna A A Damen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lotty Hooft
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Shona Kirtley
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK
| | - Richard D Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, UK, ST5 5BG
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands; EPI-centre, KU Leuven, Leuven, Belgium
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford OX3 7LD, UK; NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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11
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Song PW, Wang JL, Wang T, Zou HN, Liu YH. Creating and Testing a Model to Predict Postoperative Discomfort in Patients with Hepatocellular Carcinoma Receiving Transarterial Chemoembolisation. HEPATITIS MONTHLY 2023. [DOI: 10.5812/hepatmon-133918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
Background: Abdominal pain is a frequent adverse event in patients with hepatocellular carcinoma (HCC) after transarterial chemoembolisation (TACE). However, there remains uncertainty regarding the determinants of post-TACE pain. Objectives: We aimed to create and verify a prediction model for postoperative pain in patients with HCC after TACE treatment. Methods: This prospective study included all patients with HCC undergoing TACE in our hospital. According to the time of treatment, the dataset was divided into two cohorts (development and validation) in a 3: 2 ratio. After TACE, the participants used a visual analog scale to quantify their pain level at rest over a 24-hour period. The age, gender, tumor location, tumor size and number, medication administration route, and presence of portal vein tumor thrombosis (PVTT) were recorded in all patients. Results: In total, 137 (mean age: 60.3 ± 10.1 years; 78.1% male) and 91 (mean age: 61.1 ± 10.5 years; 73.6% male) patients were included in the development and validation cohorts, respectively. Furthermore, 46.0% and 39.6% of the patients experienced acute moderate to severe pain after TACE in the development and validation cohorts, respectively. The tumor location, the drug delivery method, and the presence of PVTT were independently associated with post-TACE pain, all of which were combined to develop a prediction model based on a logistic equation. The discrimination of this risk score was satisfactory in both the development (area under the curve (AUC): 0.693, 95% confidence interval (CI): 0.609 to 0.769, P < 0.001) and validation (AUC: 0.652, 95% CI: 0.544 to 0.748, P = 0.002) cohorts. There was no significant difference between the two cohorts (difference: 0.042, 95% CI: -0.081 to 0.164, P = 0.506). The risk score had good specificity for predicting post-TACE pain in both the development (83.8% (95% CI: 73.4% to 91.3%)) and validation (76.4% (95% CI: 63.0% to 86.8%)) cohorts. Conclusions: The presence of PVTT, the tumor location, and the drug administration method were risk factors for post-TACE discomfort. A prediction model based on these risk factors was useful for identifying patients who were vulnerable to post-TACE pain. However, further studies are required to validate these findings and optimize the model’s performance.
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12
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Okuma Y, Meguro T, Shimoda K, Miyara S, Hirotsune N. Postcoiling syndrome including headache and fever after endovascular cerebral aneurysmal coil embolization: A narrative review. Brain Circ 2023; 9:64-67. [PMID: 37576581 PMCID: PMC10419732 DOI: 10.4103/bc.bc_72_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 02/04/2023] [Accepted: 02/24/2023] [Indexed: 08/15/2023] Open
Abstract
Endovascular cerebral aneurysmal coil embolization is becoming more popular than direct aneurysmal neck clipping due to its noninferiority in long-term outcomes and being less invasive. Neuroradiologists often find postoperative symptoms such as headache and fever after unruptured aneurysmal coil embolization, however, they have not paid much attention because symptoms almost always resolve spontaneously within a few days. Since the concept of this syndrome has not been standardized, we named it postcoiling syndrome (PCS). In this short review, we reviewed the criteria, risk factors, mechanisms, significance, and treatment of PCS based on a few pieces of literature. Almost all literature has regarded that some kind of bioactive reaction might be involved in PCS. Preliminary data showed the possibility of inhibition of PCS by histamine-2 receptor antagonists. PCS also might have the potential of more predictive maker than previously reported risk factors for recurrence after aneurysm coil embolization. Further investigation is needed in the future, including the accumulation of cases, unification of concepts, and mid-to-long-term follow-up.
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Affiliation(s)
- Yu Okuma
- Department of Neurological Surgery, Sonoda Daiichi Hospital, Tokyo, Japan
| | - Toshinari Meguro
- Department of Neurological Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kentaro Shimoda
- Department of Neurological Surgery, Sonoda Daiichi Hospital, Tokyo, Japan
| | - Santiago Miyara
- Department of Neurological Surgery, Feinstein Institute for Medical Research, Northwell Health System, Manhasset, NY, USA
| | - Nobuyuki Hirotsune
- Department of Neurological Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
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13
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Song PW, Liu YH, Wang T, Yu L, Liu JL. Construction of pain prediction model for patients undergoing hepatic arterial chemoembolization. World J Surg Oncol 2023; 21:100. [PMID: 36941629 PMCID: PMC10026457 DOI: 10.1186/s12957-023-02986-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 03/14/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVE To construct a predictive model for pain in patients undergoing hepatic arterial chemoembolization (TACE) in interventional operating room. METHODS Through literature review and expert interviews, a questionnaire was prepared for the assessment of pain factors in patients with hepatic arterial chemoembolization. A prospective cohort study was used to select 228 patients with hepatic arterial chemoembolization in a tertiary and first-class hospital. The data of the patients in the pain group and the non-pain group were compared, and a rapid screening prediction model was constructed by univariate analysis and logistic regression analysis, and its prediction effect was tested. RESULTS Tumor size, liver cancer stage, and chemoembolization with drug-loaded microspheres and pirarubicin hydrochloride (THP) mixed with lipiodol were independent predictors of pain in patients after hepatic arterial chemoembolization. Finally, the pain prediction model after TACE was obtained. The results of Hosmer-Lemeshow test showed that the model fit was good (χ2 = 13.540, p = 0.095). The area under the receiver operating characteristic curve was 0.798, p < 0.001. CONCLUSION The rapid screening and prediction model of pain in patients undergoing hepatic arterial chemoembolization has certain efficacy, which is helpful for clinical screening of patients with high risk of pain, and can provide reference for predictive pain management decision-making.
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Affiliation(s)
- Ping-Wei Song
- Surgical Department 1, Yantai Yuhuangding Hospital, Yantai, 264000, China
| | - Ye-Hui Liu
- Department of Interventional Therapy, Yantai Yuhuangding Hospital, Yantai, 264000, China
| | - Tao Wang
- Department of Interventional Therapy, Yantai Yuhuangding Hospital, Yantai, 264000, China
| | - Lei Yu
- Surgical Department 1, Yantai Yuhuangding Hospital, Yantai, 264000, China
| | - Jing-Li Liu
- Catheterization Room, Yantai Yuhuangding Hospital, No. 20 Yuhuangding East Road, Zhifu District, Yantai, 264000, China.
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14
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Vanderbecq Q, Grégory J, Dana J, Dioguardi Burgio M, Garzelli L, Raynaud L, Frémy S, Paulatto L, Bouattour M, Kavafyan-Lasserre J, Vilgrain V, Ronot M. Improving pain control during transarterial chemoembolization for hepatocellular carcinoma performed under local anesthesia with multimodal analgesia. Diagn Interv Imaging 2023; 104:123-132. [PMID: 36805801 DOI: 10.1016/j.diii.2022.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to assess the performance of a reinforced analgesic protocol (RAP) on pain control in patients undergoing conventional trans-arterial chemoembolization (cTACE) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS Eighty-one consecutive patients (57 men, 24 women) with a mean age of 69 ± 10 (standard deviation) years (age range: 49-92 years) underwent 103 cTACEs. Standard antalgic protocol (50 mg hydroxyzine, 10 mg oxycodone, 8 mg ondansetron, and lidocaine for local anesthesia) was prospectively compared to a RAP (standard + 40 mg 2-h infusion nefopam and 50 mg tramadol). The individual pain risk was stratified based on age, the presence of cirrhosis and alcoholic liver disease, and patients were assigned to a low-risk group (standard protocol) or high-risk group (RAP). The primary endpoint was severe periprocedural abdominal pain (SAP), defined as a visual analog scale score ≥30/100. A predefined intermediate analysis was performed to monitor the benefit-risk of the RAP. Based on the intermediate analysis, all patients were treated with the RAP. RESULTS The intermediate analysis performed after 52 cTACE showed that 2/17 (12%) high-risk patients (i.e., those receiving the RAP) experienced SAP compared to 15/35 (43%) low-risk patients (odds ratio [OR] = 0.18; 95% confidence interval [CI]: 0.02-0.98; P = 0.03). Analysis of all procedures showed that 12/67 (18%) patients in cTACE receiving the RAP experienced SAP compared to 15/36 (42%) patients who did not receive it (OR = 3.27; 95% CI: 1.32-8.14; P = 0.01). There were no statistical differences in adverse events, particularly for nausea, between groups. CONCLUSION Reinforcing the analgesic protocol by combining non-opioid and opioid molecules reduces perioperative pain in patients undergoing cTACE for HCC.
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Affiliation(s)
- Quentin Vanderbecq
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France
| | - Jules Grégory
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France; Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation", CRI, 75018 Paris, France; FHU MOSAIC, 92110 Clichy, France
| | - Jeremy Dana
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France
| | - Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France; Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation", CRI, 75018 Paris, France
| | - Lorenzo Garzelli
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France; Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation", CRI, 75018 Paris, France
| | - Lucas Raynaud
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France
| | - Sébastien Frémy
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France
| | - Luisa Paulatto
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France
| | | | | | - Valérie Vilgrain
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France; Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation", CRI, 75018 Paris, France
| | - Maxime Ronot
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France; Université Paris Cité, INSERM U1149, "Centre de Recherche sur l'Inflammation", CRI, 75018 Paris, France; Department of Anesthesiology and Intensive Care, Hôpital Beaujon, AP-HP.Nord, 92110 Clichy, France.
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15
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Lee HN, Hyun D. Complications Related to Transarterial Treatment of Hepatocellular Carcinoma: A Comprehensive Review. Korean J Radiol 2023; 24:204-223. [PMID: 36788765 PMCID: PMC9971838 DOI: 10.3348/kjr.2022.0395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 01/27/2023] Open
Abstract
Currently, various types of transarterial treatments are performed for hepatocellular carcinoma from the early to advanced stages. Its indications and efficacy have been widely investigated. However, procedure-related complications have not been updated in the literature, although new types of transarterial treatments, such as drug-eluting bead transarterial chemoembolization and transarterial radioembolization, are common in daily practice. Herein, a comprehensive literature review was carried out, and complications were organized according to the organs affected and treatment modalities.
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Affiliation(s)
- Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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16
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Mosconi C, O'Rourke J, Kloeckner R, Sturm L, Golfieri R, Celsa C, Fateen W, Odisio BC, Garanzini EM, Peck-Radosavljevic M, Borghi A, Ma YT, Stoehr F, Bettinger D, Giuffrida P, Aithal GP, Lin YM, Spreafico C, Giampalma E, Johnson P, Cucchetti A. Textbook Outcome After Trans-arterial Chemoembolization for Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 2023; 46:449-459. [PMID: 36849836 DOI: 10.1007/s00270-023-03375-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/27/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Textbook Outcome (TO) is inclusive of quality indicators and it not been provided for trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS Data on treatment-naïve HCC patients receiving TACE from 10 centers were reviewed. TO was defined as "no post-TACE grade 3-4 complications, no prolonged hospital stay (defined as a post-procedure stay ≤ 75th percentile of the median values from the total cohort), no 30-day mortality/readmission and the achievement of an objective response (OR) at post-TACE imaging." Grade of adverse event was classified according to the Common Terminology Criteria for Adverse Events and short-term efficacy was assessed by response. Pooled estimates were calculated to account for hospital's effect and risk-adjustment was applied to allow for diversity of patients in each center. RESULTS A total of 1124 patients (2014-2018) fulfilling specific inclusion criteria were included. Baseline clinical features showed considerable heterogeneity (I2 > 0.75) across centers. TACE-related mortality was absent in 97.6%, readmission was not required after 94.9% of procedures, 91.5% of patients had no complication graded 3-4, 71.8% of patients did not require prolonged hospitalization, OR of the target lesion was achieved in 68.5%. Risk-adjustment showed that all indicators were achieved in 43.1% of patients, and this figure was similar across centers. The median overall survival for patients who achieved all indicators was 33.1 months, 11.9 months longer than for patients who did not. CONCLUSIONS A useful benchmark for TACE in HCC patients has been developed, which provides an indication of survival and allows for a comparison of treatment quality across different hospitals.
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Affiliation(s)
- Cristina Mosconi
- Department of Diagnostic Medicine and Prevention, Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Via Albertoni 15, 40138, Bologna, Italy.
| | - Joanne O'Rourke
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, Medical School, University of Birmingham, Birmingham, UK
| | - Roman Kloeckner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Lukas Sturm
- Department of Medicine II, Faculty of Medicine, Medical Center University of Freiburg, University of Freiburg, Hugstetter Street 55, 79106, Freiburg, Germany.,Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rita Golfieri
- Department of Diagnostic Medicine and Prevention, Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Sant'Orsola-Malpighi Hospital, Via Albertoni 15, 40138, Bologna, Italy
| | - Ciro Celsa
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Marina, Italy
| | - Waleed Fateen
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, The University of Nottingham, Nottingham, UK
| | - Bruno C Odisio
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Markus Peck-Radosavljevic
- Department of Internal Medicine and Gastroenterology, Klinikum Klagenfurt Am Wörthersee, Klagenfurt, Austria
| | - Alberto Borghi
- Department of Internal Medicine, Infermi Hospital, Area Vasta Romagna, Faenza, Italy
| | - Yuk Ting Ma
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, Medical School, University of Birmingham, Birmingham, UK
| | - Fabian Stoehr
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Dominik Bettinger
- Department of Medicine II, Faculty of Medicine, Medical Center University of Freiburg, University of Freiburg, Hugstetter Street 55, 79106, Freiburg, Germany.,Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Paolo Giuffrida
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Marina, Italy
| | - Guruprasad P Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, The University of Nottingham, Nottingham, UK
| | - Yuan-Mao Lin
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlo Spreafico
- Department of Radiology, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | | | - Philip Johnson
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Alessandro Cucchetti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.,Morgagni-Pierantoni Hospital, Area Vasta Romagna, Forlì, Italy
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17
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You K, Guo T, Sun D, Song H, Liu Z. Transradial versus transfemoral approach for TACE: a retrospective study. BMC Gastroenterol 2023; 23:11. [PMID: 36631744 PMCID: PMC9835221 DOI: 10.1186/s12876-023-02646-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Transcatheter arterial chemoembolization (TACE) has been widely applied in the treatment of hepatocellular carcinoma (HCC). Our study aimed to investigate the feasibility and efficacy of transradial access as an alternative to transfemoral access for TACE. METHODS Patients undergoing TACE were divided into the radial artery (RA) route group or the femoral artery (FA) route group according to the operation approach, namely, transradial or transfemoral access. We retrospectively analysed the clinical characteristics, technical outcomes, clinical efficacy and incidence of adverse events to compare the two technologies for intervention for HCC. RESULTS Transradial access was found to achieve superior technical outcomes and clinical efficacy, as the patients in the RA group had a lower rate of hepatic arterial spasm, a higher partial response rate and a lower progression rate than the patients in the FA group according to the mRECIST evaluations. In contrast, the liver function indices and VAS (visual analogue scale) pain scores were consistent across the two groups. Moreover, patients in the RA group had a shorter length of stay than those in the FA group, despite similar hospitalization expenses. The total adverse events were significantly reduced by transradial access for TACE (72.5% vs. 84.1%, P = 0.027). CONCLUSION Our study suggested that transradial access is an effective and feasible alternative to transfemoral access for TACE. Large-scale prospective randomized controlled studies are expected.
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Affiliation(s)
- Ke You
- grid.412461.40000 0004 9334 6536Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Linjiang Road 74, Chongqing, 400010 China
| | - Tao Guo
- grid.477425.7Liuzhou Key Laboratory of Infection Disease and ImmunologyGuangxi Health Commission Key Laboratory of Clinical Biotechnology, Liuzhou People’s Hospital affiliated to Guangxi Medical University, Liuzhou, 545006 China ,grid.268079.20000 0004 1790 6079Department of Pathophysiology, School of Basic Medical Sciences, Weifang Medical University, Weifang, 261053 China
| | - Da Sun
- Department of Organ Transplantation, Third Affiliated Hospital of Naval Military Medical University, North Moyu Road 700, Shanghai, 201805 China
| | - Hao Song
- Department of Organ Transplantation, Third Affiliated Hospital of Naval Military Medical University, North Moyu Road 700, Shanghai, 201805 China
| | - Zuojin Liu
- grid.412461.40000 0004 9334 6536Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Chongqing Medical University, Linjiang Road 74, Chongqing, 400010 China
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18
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Liu YS, Chang PY, Liang PC, Ou MC, Hwang JI, Chen CH. Safety and Efficacy of Drug-Eluting Beads Trans-Arterial Chemoembolization for Hepatocellular Carcinoma in Taiwan (SERENADE-T). J Hepatocell Carcinoma 2022; 9:811-821. [PMID: 35996398 PMCID: PMC9391935 DOI: 10.2147/jhc.s374555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/09/2022] [Indexed: 01/27/2023] Open
Abstract
Purpose The aim of this retrospective study was to evaluate the safety and efficacy of patients with hepatocellular carcinoma treated with drug-eluting bead with doxorubicin transarterial chemoembolization (DEBDOX-TACE) in Taiwan. Patients and Methods We retrospectively investigated 630 hepatocellular carcinoma patients who underwent DEBDOX-TACE in multiple institutions from 2011 to 2016 in Taiwan. Tumor response was assessed per modified response evaluation criteria in solid tumors, overall survival, and safety. Results This study included 630 patients who underwent DEBDOX-TACE, participants’ mean age was 66 years, 68.1% males and 15.6% females. The mean doxorubicin dose administered via DEBDOX-TACE was 56 mg. Complete and partial response rates were 14.6% and 49.2%, respectively, with a disease control rate of 84.6%. The median overall survival was 29.2 months. The most common post-embolization symptom was abdominal pain (22.4%). No hepatic encephalopathy and no procedure-related death were found. Conclusion Real-world data from Taiwan demonstrated that DEBDOX-TACE for hepatocellular carcinoma can achieve high tumor response rate with low adverse events.
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Affiliation(s)
- Yi-Sheng Liu
- Department of Medical Imaging, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pi-Yi Chang
- Department of Radiology, Taichung Veterans General Hospital, Taichung City, Taiwan
| | - Po-Chin Liang
- Department of Radiology, National Taiwan University Hospital, Taipei City, Taiwan
| | - Ming-Ching Ou
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jen-I Hwang
- Department of Medical Imaging, Tungs' Taichung MetroHarbor Hospital, Taichung City, Taiwan.,Department of Radiology, School of Medicine, National Defense Medical Center, Taipei City, Taiwan
| | - Chien-Hung Chen
- Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Douliu City, Yunlin County, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei City, Taiwan
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19
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Boumezrag M, Banovac F. Oncologic Interventions: Periprocedural Medications. Semin Intervent Radiol 2022; 39:406-410. [PMID: 36406027 PMCID: PMC9671681 DOI: 10.1055/s-0042-1758079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Significant advances in ablative and endovascular therapies have allowed interventional radiology to play a substantial role in the management of patients with malignant neoplasms. The evolution of these procedures and the optimization of patient outcomes and experience must take into account various elements of the periprocedural period. Some of the most important considerations within the periprocedural period are the pharmacologic agents used to avoid infectious complications, decrease pain, and manage side effects. In this article, we discuss some of the most commonly used medications in interventional oncology procedures including antibiotics, narcotics, sedatives, antiemetics, and others.
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Affiliation(s)
- Maryam Boumezrag
- Department of Radiology, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Filip Banovac
- Division of Interventional Oncology, Department of Radiology, MedStar Georgetown University Hospital, Washington, District of Columbia
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20
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Dhiman P, Ma J, Andaur Navarro CL, Speich B, Bullock G, Damen JAA, Hooft L, Kirtley S, Riley RD, Van Calster B, Moons KGM, Collins GS. Methodological conduct of prognostic prediction models developed using machine learning in oncology: a systematic review. BMC Med Res Methodol 2022; 22:101. [PMID: 35395724 PMCID: PMC8991704 DOI: 10.1186/s12874-022-01577-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/18/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Describe and evaluate the methodological conduct of prognostic prediction models developed using machine learning methods in oncology. METHODS We conducted a systematic review in MEDLINE and Embase between 01/01/2019 and 05/09/2019, for studies developing a prognostic prediction model using machine learning methods in oncology. We used the Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement, Prediction model Risk Of Bias ASsessment Tool (PROBAST) and CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS) to assess the methodological conduct of included publications. Results were summarised by modelling type: regression-, non-regression-based and ensemble machine learning models. RESULTS Sixty-two publications met inclusion criteria developing 152 models across all publications. Forty-two models were regression-based, 71 were non-regression-based and 39 were ensemble models. A median of 647 individuals (IQR: 203 to 4059) and 195 events (IQR: 38 to 1269) were used for model development, and 553 individuals (IQR: 69 to 3069) and 50 events (IQR: 17.5 to 326.5) for model validation. A higher number of events per predictor was used for developing regression-based models (median: 8, IQR: 7.1 to 23.5), compared to alternative machine learning (median: 3.4, IQR: 1.1 to 19.1) and ensemble models (median: 1.7, IQR: 1.1 to 6). Sample size was rarely justified (n = 5/62; 8%). Some or all continuous predictors were categorised before modelling in 24 studies (39%). 46% (n = 24/62) of models reporting predictor selection before modelling used univariable analyses, and common method across all modelling types. Ten out of 24 models for time-to-event outcomes accounted for censoring (42%). A split sample approach was the most popular method for internal validation (n = 25/62, 40%). Calibration was reported in 11 studies. Less than half of models were reported or made available. CONCLUSIONS The methodological conduct of machine learning based clinical prediction models is poor. Guidance is urgently needed, with increased awareness and education of minimum prediction modelling standards. Particular focus is needed on sample size estimation, development and validation analysis methods, and ensuring the model is available for independent validation, to improve quality of machine learning based clinical prediction models.
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Affiliation(s)
- Paula Dhiman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK.
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | - Jie Ma
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Constanza L Andaur Navarro
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Benjamin Speich
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
- Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Garrett Bullock
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Johanna A A Damen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Lotty Hooft
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Shona Kirtley
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
| | - Richard D Riley
- Centre for Prognosis Research, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
- EPI-centre, KU Leuven, Leuven, Belgium
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, OX3 7LD, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Association of Cirrhosis and Other Patient and Procedural Characteristics With Postembolization Syndrome after Bland Hepatic Artery Embolization for Hepatic Malignancy. AJR Am J Roentgenol 2022; 218:1030-1039. [DOI: 10.2214/ajr.21.26806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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22
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Lyu N, Kong Y, Li X, Guo N, Lai J, Li J, Zhao M. Effect and Safety of Prophylactic Parecoxib for Pain Control of Transarterial Chemoembolization in Liver Cancer: A Single-Center, Parallel-Group, Randomized Trial. J Am Coll Radiol 2021; 19:61-70. [PMID: 34736908 DOI: 10.1016/j.jacr.2021.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Pain is one of the most common side effects of transarterial chemoembolization (TACE) in patients with unresectable hepatocellular carcinoma. The goal of this study is to compare the analgesic effect among celecoxib, parecoxib, and oxycodone in patients undergoing TACE. METHODS This prospective study was a randomized, paralleled trial in which 213 patients were enrolled. Patients were assigned at the ratio of 1:1:1 to receive celecoxib, parecoxib, or controlled-release oxycodone 1 hour before TACE (T0) and once every 12 hours for 2 days after TACE. Pain scores, pain intensity, and adverse events in each time interval were evaluated and compared among the 3 groups. RESULTS The mean pain score 12 hours after T0 in the parecoxib group (2.8) was lower than that in the celecoxib (4.4; P = .001) and oxycodone groups (4.2; P = .005). The number of patients suffering severe pain was 10 (14.7%) in the parecoxib, 25 (36.8%) in the celecoxib, and 23 (32.9%) in the oxycodone groups (P = .009). Twelve hours after T0, the incidence of grade 3 vomiting in the parecoxib group (2.9%) was significantly lower than that in the oxycodone group (17.1%; P = .006). In the multivariate analysis, nonparecoxib prophylactic analgesia (odds ratio [OR], 4.620; 95% confidence interval [CI], 1.877-11.370; P = .001) as well as embolization of the gallbladder (OR, 8.666; 95% CI, 2.402-31.262; P = .001) and normal liver parenchyma (OR, 3.278; 95% CI, 1.409-7.627; P = .006) were the independent factors of severe pain intensity 12 hours after T0. CONCLUSION Parecoxib is superior to oxycodone and celecoxib for pain control with fewer adverse events. Therefore, we recommend parecoxib as a priority strategy for TACE-related pain control.
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Affiliation(s)
- Ning Lyu
- Department of Minimally Invasive Interventional Radiology, Liver Cancer Study and Service Group, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yanan Kong
- Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Department of Breast Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaoxian Li
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Na Guo
- Department of Anesthesiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jinfa Lai
- Department of Minimally Invasive Interventional Radiology, Liver Cancer Study and Service Group, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Jibin Li
- Department of Clinical Research, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Ming Zhao
- Department of Minimally Invasive Interventional Radiology, Liver Cancer Study and Service Group, Sun Yat-sen University Cancer Center, Guangzhou, China.
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23
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Wang LZ, Hu XX, Shen XC, Wang TC, Zhou S. Intraarterial Lidocaine Administration for Pain Control by Water-in-Oil Technique in Transarterial Chemoembolization: in vivo and Randomized Clinical Trial. J Hepatocell Carcinoma 2021; 8:1221-1232. [PMID: 34676180 PMCID: PMC8502067 DOI: 10.2147/jhc.s331779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/23/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the sustained release of lidocaine from a lidocaine–epirubicin–lipiodol emulsion created by water-in-oil (W/O) technique in vivo and evaluate the efficacy and safety of intraarterial lidocaine administration for intra- and postoperative pain control in transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Methods The in vivo concentrations of lidocaine were determined in tumor tissues after VX2 rabbit models for hepatic tumor were administered with intra-arterial lidocaine–epirubicin–lipiodol emulsion. A prospective randomized controlled clinical trial was performed, enrolling 70 consecutive patients who underwent TACE. Patients were randomized into two groups: Group A received an immediate bolus intraarterial lidocaine injection before TACE, and Group B received a lidocaine–epirubicin–lipiodol emulsion during TACE. Pain intensity was compared between the two groups using a visual analog scale (VAS) score before (Tbefore) and at 0 h (T0), 4 h (T4), 8 h (T8), 24 h (T24), 48 h (T48), and 72 h (T72) after the procedure. Adverse events and intake of analgesics were evaluated and compared between the two groups. Results The concentrations of lidocaine in tumor tissues were higher in experimental group than in control group at T0.5 (P=0.004), T1 (P=0.038), T4 (P=0.036), and T8 (P=0.029). In the clinical trial, VAS scores in Group B were significantly lower than in Group A at T0 (P=0.006), T4 (P=0.001), T8 (P=0.002), and T24 (P=0.005). The tramadol intake in Group B was significantly lower than in Group A (P=0.021). No significant difference was observed regarding the incidence of adverse events between the two groups. Conclusion This study demonstrated the effectiveness and safety of intraarterial lidocaine administration using the W/O technique in controlling intra- and post-TACE pain.
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Affiliation(s)
- Li-Zhou Wang
- Department of Interventional Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
| | - Xiao-Xia Hu
- The State Laboratory of Functions and Application of Medicinal Plants, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
| | - Xiang-Chun Shen
- The State Laboratory of Functions and Application of Medicinal Plants, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China.,School of Pharmaceutical Sciences, Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
| | - Tian-Cheng Wang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Shi Zhou
- Department of Interventional Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
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24
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Li QJ, He MK, Chen HW, Fang WQ, Zhou YM, Xu L, Wei W, Zhang YJ, Guo Y, Guo RP, Chen MS, Shi M. Hepatic Arterial Infusion of Oxaliplatin, Fluorouracil, and Leucovorin Versus Transarterial Chemoembolization for Large Hepatocellular Carcinoma: A Randomized Phase III Trial. J Clin Oncol 2021; 40:150-160. [PMID: 34648352 DOI: 10.1200/jco.21.00608] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE In a previous phase II trial, hepatic arterial infusion chemotherapy (HAIC) with infusional fluorouracil, leucovorin, and oxaliplatin (FOLFOX) yielded higher treatment responses than transarterial chemoembolization (TACE) in large unresectable hepatocellular carcinoma. We aimed to compare the overall survival of patients treated with FOLFOX-HAIC versus TACE as first-line treatment in this population. METHODS In this randomized, multicenter, open-label trial, adults with unresectable hepatocellular carcinoma (largest diameter ≥ 7 cm) without macrovascular invasion or extrahepatic spread were randomly assigned 1:1 to FOLFOX-HAIC (oxaliplatin 130 mg/m2, leucovorin 400 mg/m2, fluorouracil bolus 400 mg/m2 on day 1, and fluorouracil infusion 2,400 mg/m2 for 24 hours, once every 3 weeks) or TACE (epirubicin 50 mg, lobaplatin 50 mg, and lipiodol and polyvinyl alcohol particles). The primary end point was overall survival by intention-to-treat analysis. Safety was assessed in patients who received ≥ 1 cycle of study treatment. RESULTS Between October 1, 2016, and November 23, 2018, 315 patients were randomly assigned to FOLFOX-HAIC (n = 159) or TACE (n = 156). The median overall survival in the FOLFOX-HAIC group was 23.1 months (95% CI, 18.5 to 27.7) versus 16.1 months (95% CI, 14.3 to 17.9) in the TACE group (hazard ratio, 0.58; 95% CI, 0.45 to 0.75; P < .001). The FOLFOX-HAIC group showed a higher response rate than the TACE group (73 [46%] v 28 [18%]; P < .001) and a longer median progression-free survival (9.6 [95% CI, 7.4 to 11.9] v 5.4 months [95% CI, 3.8 to 7.0], P < .001). The incidence of serious adverse events was higher in the TACE group than in the FOLFOX-HAIC group (30% v 19%, P = .03). Two deaths in the FOLFOX-HAIC group and two in the TACE group were deemed to be treatment-related. CONCLUSION FOLFOX-HAIC significantly improved overall survival over TACE in patients with unresectable large hepatocellular carcinoma.
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Affiliation(s)
- Qi-Jiong Li
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Min-Ke He
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | | | | | - Yuan-Min Zhou
- Guangzhou No. 12 People's Hospital, Guangzhou, China
| | - Li Xu
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Wei Wei
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Yao-Jun Zhang
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ying Guo
- Department of Clinical Research, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Rong-Ping Guo
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Min-Shan Chen
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ming Shi
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
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Wang TC, An TZ, Li JX, Pang PF. Systemic Inflammation Response Index is a Prognostic Risk Factor in Patients with Hepatocellular Carcinoma Undergoing TACE. Risk Manag Healthc Policy 2021; 14:2589-2600. [PMID: 34188570 PMCID: PMC8232961 DOI: 10.2147/rmhp.s316740] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 06/02/2021] [Indexed: 12/12/2022] Open
Abstract
Background Mounting evidence has shown that systemic inflammation response index (SIRI), a novel prognostic biomarker based on peripheral lymphocyte, neutrophil and monocyte counts, is associated with poor prognosis for several tumors. However, the prognostic value of SIRI in patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE) is elusive. Herein, we aimed to evaluate the correlation between SIRI and clinical outcomes in these patients. Methods A total of 194 consecutive patients who underwent TACE were included in this study. Patients were stratified into high and low SIRI groups based on the cut-off value using receiver operating characteristic (ROC) analysis. Independent risk factors for tumor response were analyzed using forward stepwise logistic regression. A one-to-one propensity score matching (PSM) was conducted to compare progression-free survival (PFS) and overall survival (OS) between low and high SIRI patients. The discriminatory power of the combination of number of tumors and SIRI in predicting initial TACE response was evaluated by ROC analysis. Results Patients were divided into high SIRI (> 0.88) and low SIRI (≤ 0.88) groups. High SIRI (p = 0.003) and more than three tumors (p = 0.002) were significantly related to poorer tumor response. Moreover, the low SIRI group had longer PFS and OS than the high SIRI group (both P < 0.05) before and after PSM. Combination of SIRI and number of tumors can improve the predictive ability to predict initial TACE response with an area under the curve (AUC) of 0.678. Conclusion Pretreatment peripheral blood SIRI was found to be an independent predictor of tumor response and clinical outcomes in patients with HCC undergoing TACE. Patients with high SIRI may have a poor prognosis.
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Affiliation(s)
- Tian-Cheng Wang
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China.,Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Tian-Zhi An
- Department of Interventional Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
| | - Jun-Xiang Li
- Department of Interventional Radiology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, Guizhou, People's Republic of China
| | - Peng-Fei Pang
- Department of Interventional Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, People's Republic of China
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Lu H, Zheng C, Liang B, Xiong B. Efficacy and safety analysis of dexamethasone-lipiodol emulsion in prevention of post-embolization syndrome after TACE: a retrospective analysis. BMC Gastroenterol 2021; 21:256. [PMID: 34116638 PMCID: PMC8196541 DOI: 10.1186/s12876-021-01839-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/03/2021] [Indexed: 02/07/2023] Open
Abstract
Background To investigate the efficacy and safety of dexamethasone-lipiodol emulsion in the prevention of post-embolization syndrome after TACE. Method The data of 255 patients who underwent TACE in the interventional department from June 2017 to June 2020 were collected. This is a retrospective assessment of patients who were non-randomly treated with dexamethasone in TACE. The patients were divided into two groups: TACE using lipiodol + chemotherapeutic emulsion group (TACE group, N = 133); TACE using lipiodol + dexamethasone + chemotherapeutic emulsion group (TACE + dexamethasone group, N = 122). Primary study endpoint: incidence of abdominal pain, fever, nausea and vomiting 0–72 h after TACE in both groups. Secondary study endpoints: incidence of infection after TACE in both groups. Results Incidence of post-embolization syndrome after TACE (TACE group vs TACE + dexamethasone group): abdominal pain, 55.6% versus 36.1% (P value 0.002); fever, 37.6% versus 13.1% (P value 0.000); nausea, 60.9% versus 41.0% (P value 0.001); vomiting, 48.1% versus 21.3% (P value 0.000). Incidence of infection after TACE (TACE group vs TACE + dexamethasone group): 1.5% versus 2.5% (P value 0.583). Conclusion The lipiodol + dexamethasone emulsion can significantly reduce the incidence rate of post-embolization syndrome after TACE, with exact effect and high safety.
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Affiliation(s)
- Haohao Lu
- Department of Radiology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chuansheng Zheng
- Department of Radiology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China. .,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Bin Liang
- Department of Radiology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Bin Xiong
- Department of Radiology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue #1277, Wuhan, 430022, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
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27
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Pan Y, Chang R, He Z, Hong M. How to prophylactically alleviate postembolization syndrome following transarterial chemoembolization?: Protocol of a double blinded, randomized, placebo-controlled trial. Medicine (Baltimore) 2021; 100:e25360. [PMID: 33832116 PMCID: PMC10545327 DOI: 10.1097/md.0000000000025360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, and most patients in China are diagnosed at the intermediate or later stages, which is not suitable for the first line therapies. Transarterial chemoembolization (TACE) is a commonly selected therapeutic option for intermediate and later stage HCC in China, but patients often suffer from postembolization syndrome (PES), manifesting as fever, liver area pain, nausea, vomiting, paralyzed intestinal obstruction, and abdominal pain after TACE. We try to conduct a double blinded, randomized, placebo-controlled clinical trial to observe whether Chaihu Guizhi decoction (CGD), a classic traditional Chinese formula, could prophylactically alleviate the incidence of PES in HCC patients after TACE. METHODS Patients will be randomly assigned sequentially in a 1:1 ratio by using preformed randomization envelopes. After TACE procedures, patients in the treatment group will be administrated with Chinese herbal formula CGD, and patients in the control group with CGD simulations, twice a day, continuously for 7 days. The outcomes are the incidence of PES hospitalization and, complications. SPSS version 22 (IBM, Chicago, IL) will be used for the data, and a P < .05 will be considered statistically significant. CONCLUSIONS The findings will explore the prophylactic effect of CGD in alleviating the incidence of PES following TACE in HCC patients. TRIAL REGISTRATION OSF Registration number: DOI 10.17605/OSF.IO/FKRSN.
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Affiliation(s)
- Yi Pan
- The Ninth People's Hospital of Chongqing
| | - Rui Chang
- Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, Chongqing City, China
| | | | - Ming Hong
- The Ninth People's Hospital of Chongqing
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Zou ZM, Chang DH, Liu H, Xiao YD. Current updates in machine learning in the prediction of therapeutic outcome of hepatocellular carcinoma: what should we know? Insights Imaging 2021; 12:31. [PMID: 33675433 PMCID: PMC7936998 DOI: 10.1186/s13244-021-00977-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/15/2021] [Indexed: 12/24/2022] Open
Abstract
With the development of machine learning (ML) algorithms, a growing number of predictive models have been established for predicting the therapeutic outcome of patients with hepatocellular carcinoma (HCC) after various treatment modalities. By using the different combinations of clinical and radiological variables, ML algorithms can simulate human learning to detect hidden patterns within the data and play a critical role in artificial intelligence techniques. Compared to traditional statistical methods, ML methods have greater predictive effects. ML algorithms are widely applied in nearly all steps of model establishment, such as imaging feature extraction, predictive factor classification, and model development. Therefore, this review presents the literature pertaining to ML algorithms and aims to summarize the strengths and limitations of ML, as well as its potential value in prognostic prediction, after various treatment modalities for HCC.
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Affiliation(s)
- Zhi-Min Zou
- Department of Radiology, The Second Xiangya Hospital of Central South University, No.139 Middle Renmin Road, Changsha, 410011, China
| | - De-Hua Chang
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Hui Liu
- Department of Radiology, The Second Xiangya Hospital of Central South University, No.139 Middle Renmin Road, Changsha, 410011, China
| | - Yu-Dong Xiao
- Department of Radiology, The Second Xiangya Hospital of Central South University, No.139 Middle Renmin Road, Changsha, 410011, China.
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Agrawal R, Majeed M, Aqeel SB, Wang Y, Haque Z, Omar YA, Upadhyay SB, Gast T, Attar BM, Gandhi S. Identifying predictors and evaluating the role of steroids in the prevention of post-embolization syndrome after transarterial chemoembolization and bland embolization. Ann Gastroenterol 2021; 34:241-246. [PMID: 33654366 PMCID: PMC7903567 DOI: 10.20524/aog.2020.0566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023] Open
Abstract
Background Transarterial chemoembolization (TACE) and bland embolization (TAE), performed for hepatocellular carcinoma (HCC), are often complicated by post-embolization syndrome (PES). There are limited data regarding the incidence of PES after TAE and the role of steroids in PES. We report the incidence of PES post TACE and TAE, identify predictors, and evaluate the role of steroids in PES. Methods Demographic and clinical variables of patients who underwent embolization were collected and PES was identified. Risk factors for PES, TACE and TAE were derived by logistic regression. We compared patients who received dexamethasone to those who did not, regarding baseline characteristics, occurrence of PES, and hospital stay. Results A total of 171 patients, average age 60.5 years, underwent the procedure, 77.8% were male, and 87.7% had cirrhosis. Of these 171, 107 underwent TACE and 64 TAE. Dexamethasone was given to 106 (61.9%) patients, of whom 85 had TACE and 21 TAE. One hundred twenty-four patients (72.5%) developed PES. PES occurred in more patients who underwent TACE, 80 (74.7%) vs. 44 (68.7%), and resulted in a longer hospital stay (1.47 vs. 1.12 days, P=0.034). Predictive factors for PES included female sex (odds ratio [OR] 2.76, 95% confidence interval [CI] 1.04-7.34; P=0.041), and alcohol-related HCC (OR 3.14, 95%CI 1.42-6.95; P=0.005). Dexamethasone did not affect the length of hospital stay (1.43 vs. 1.29 days, P=0.422) or the rate of prolonged hospitalization (18.8% vs. 15.4%, P=0.561). Conclusion There was no difference in the incidence of PES following TACE or TAE and the use of dexamethasone did not reduce the incidence of PES or the duration of hospital stay.
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Affiliation(s)
- Rohit Agrawal
- Department of Medicine (Rohit Agrawal, Muhammad Majeed, Sheeba-Ba Aqeel, Zohaib Haque, Yazan Abu Omar, Shristi Banskota Upadhyay)
| | - Muhammad Majeed
- Department of Medicine (Rohit Agrawal, Muhammad Majeed, Sheeba-Ba Aqeel, Zohaib Haque, Yazan Abu Omar, Shristi Banskota Upadhyay)
| | - Sheeba-Ba Aqeel
- Department of Medicine (Rohit Agrawal, Muhammad Majeed, Sheeba-Ba Aqeel, Zohaib Haque, Yazan Abu Omar, Shristi Banskota Upadhyay)
| | - Yuchen Wang
- Division of Gastroenterology and Hepatology, Department of Medicine (Bashar Attar, Seema Gandhi)
| | - Zohaib Haque
- Department of Medicine (Rohit Agrawal, Muhammad Majeed, Sheeba-Ba Aqeel, Zohaib Haque, Yazan Abu Omar, Shristi Banskota Upadhyay)
| | - Yazan Abu Omar
- Department of Medicine (Rohit Agrawal, Muhammad Majeed, Sheeba-Ba Aqeel, Zohaib Haque, Yazan Abu Omar, Shristi Banskota Upadhyay)
| | - Shristi Banskota Upadhyay
- Department of Medicine (Rohit Agrawal, Muhammad Majeed, Sheeba-Ba Aqeel, Zohaib Haque, Yazan Abu Omar, Shristi Banskota Upadhyay)
| | - Thomas Gast
- Division of Radiology and Diagnostic Imaging (Thomas Gast), Cook County Health and Hospital System, IL, USA
| | - Bashar M Attar
- Division of Gastroenterology and Hepatology, Department of Medicine (Bashar Attar, Seema Gandhi)
| | - Seema Gandhi
- Division of Gastroenterology and Hepatology, Department of Medicine (Bashar Attar, Seema Gandhi)
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Han K, Kim JH, Yang SG, Park SH, Choi HK, Chun SY, Kim PN, Park J, Lee M. A Single-Center Retrospective Analysis of Periprocedural Variables Affecting Local Tumor Progression after Radiofrequency Ablation of Colorectal Cancer Liver Metastases. Radiology 2020; 298:212-218. [PMID: 33170105 DOI: 10.1148/radiol.2020200109] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Local tumor progression (LTP) is associated with poorer survival in patients undergoing radiofrequency ablation (RFA) for colorectal liver metastasis (CLM). An algorithmic strategy to predict LTP may help in selection of patients who would benefit most from RFA for CLM. Purpose To estimate local tumor progression-free survival (LTPFS) following RFA of CLM and develop an algorithmic strategy based on clinical variables. Materials and Methods In this retrospective study, between March 2000 and December 2014, patients who underwent percutaneous RFA for CLM were randomly split into development (60%) and internal validation (40%) data sets. Kaplan-Meier method was used to estimate LTPFS and overall survival (OS) rates. Independent factors affecting LTPFS in the development data set were investigated by using multivariable Cox proportional hazard regression analysis. Risk scores were assigned to the risk factors and applied to the validation data set. Results A total of 365 patients (mean age, 60 years ± 11 [standard deviation]; 259 men) with 512 CLMs were evaluated. LTPFS and OS rates were 85% and 92% at 1 year, 73% and 41% at 5 years, 72% and 30% at 10 years, and 72% and 28% at 15 years, respectively. Independent risk factors for LTP included tumor size of 2 cm or greater (hazard ratio [HR], 3.8; 95% CI: 2.3, 6.2; P < .001), subcapsular tumor location (HR, 1.9; 95% CI: 1.1, 3.1; P = .02), and minimal ablative margin of 5 mm or less (HR, 11.7; 95% CI: 4.7, 29.2; P < .001). A prediction model that used the risk factors had areas under the curve of 0.89, 0.92, and 0.90 at 1, 5, and 10 years, respectively, and it showed significantly better areas under the curve when compared with the model using the minimal ablative margin of 5 mm or less alone. Conclusion Radiofrequency ablation provided long-term control of colorectal liver metastases. Although minimal ablative margin of 5 mm or less was the most dominant factor, the multifactorial approach including tumor size and subcapsular location better predicted local tumor progression-free survival. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Soulen and Sofocleous in this issue.
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Affiliation(s)
- Kichang Han
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Jin Hyoung Kim
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Seul Gi Yang
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Seong Ho Park
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Hyun-Kyung Choi
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Seng-Yong Chun
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Pyo Nyun Kim
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Jihong Park
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
| | - Myeongjee Lee
- From the Department of Radiology, Severance Hospital, Research Institute of Radiological Science (K.H.), and Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics (M.L.), Yonsei University College of Medicine, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro, 43-gil, Songpa-gu, Seoul, 138-736, Korea (J.H.K., S.G.Y., S.H.P., H.K.C., S.Y.C., P.N.K., J.P.)
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Bian LF, Zhao XH, Gao BL, Zhang S, Ge GM, Zhan DD, Ye TT, Zheng Y. Predictive model for acute abdominal pain after transarterial chemoembolization for liver cancer. World J Gastroenterol 2020; 26:4442-4452. [PMID: 32874056 PMCID: PMC7438199 DOI: 10.3748/wjg.v26.i30.4442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/08/2020] [Accepted: 07/18/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Transarterial chemoembolization (TACE) is the first-line treatment for patients with unresectable liver cancer; however, TACE is associated with postembolization pain.
AIM To analyze the risk factors for acute abdominal pain after TACE and establish a predictive model for postembolization pain.
METHODS From January 2018 to September 2018, all patients with liver cancer who underwent TACE at our hospital were included. General characteristics; clinical, imaging, and procedural data; and postembolization pain were analyzed. Postembolization pain was defined as acute moderate-to-severe abdominal pain within 24 h after TACE. Logistic regression and a classification and regression tree were used to develop a predictive model. Receiver operating characteristic curve analysis was used to examine the efficacy of the predictive model.
RESULTS We analyzed 522 patients who underwent a total of 582 TACE procedures. Ninety-seven (16.70%) episodes of severe pain occurred. A predictive model built based on the dataset from classification and regression tree analysis identified known invasion of blood vessels as the strongest predictor of subsequent performance, followed by history of TACE, method of TACE, and history of abdominal pain after TACE. The area under the receiver operating characteristic curve was 0.736 [95% confidence interval (CI): 0.682-0.789], the sensitivity was 73.2%, the specificity was 65.6%, and the negative predictive value was 92.4%. Logistic regression produced similar results by identifying age [odds ratio (OR) = 0.971; 95%CI: 0.951-0.992; P = 0.007), history of TACE (OR = 0.378; 95%CI: 0.189-0.757; P = 0.007), history of abdominal pain after TACE (OR = 6.288; 95%CI: 2.963-13.342; P < 0.001), tumor size (OR = 1.978; 95%CI: 1.175-3.330; P = 0.01), multiple tumors (OR = 2.164; 95%CI: 1.243-3.769; P = 0.006), invasion of blood vessels (OR = 1.756; 95%CI: 1.045-2.950; P = 0.034), and TACE with drug-eluting beads (DEB-TACE) (OR = 2.05; 95%CI: 1.260-3.334; P = 0.004) as independent predictive factors for postembolization pain.
CONCLUSION Blood vessel invasion, TACE history, TACE with drug-eluting beads, and history of abdominal pain after TACE are predictors of acute moderate-to-severe pain. The predictive model may help medical staff to manage pain.
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Affiliation(s)
- Li-Fang Bian
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Xue-Hong Zhao
- Department of Nursing, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Bei-Lei Gao
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Sheng Zhang
- Department of Hospital Infection Control, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Guo-Mei Ge
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Dong-Di Zhan
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Ting-Ting Ye
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
| | - Yan Zheng
- Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, Zhejiang Province, China
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Khalaf MH, Shah RP, Green V, Vezeridis AM, Liang T, Kothary N. Comparison of Opioid Medication Use after Conventional Chemoembolization versus Drug-Eluting Embolic Chemoembolization. J Vasc Interv Radiol 2020; 31:1292-1299. [PMID: 32654960 DOI: 10.1016/j.jvir.2020.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/04/2020] [Accepted: 04/08/2020] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To assess the use of opioid analgesics and/or antiemetic drugs for pain and nausea following selective chemoembolization with doxorubicin-based conventional (c)-transarterial chemoembolization versus drug-eluting embolic (DEE)-transarterial chemoembolization for hepatocellular carcinoma (HCC). MATERIALS AND METHODS From October 2014 to 2016, 283 patients underwent 393 selective chemoembolization procedures including 188 patients (48%) who underwent c-transarterial chemoembolization and 205 (52%) who underwent DEE-transarterial chemoembolization. Medical records for all patients were retrospectively reviewed. Administration of postprocedural opioid and/or antiemetic agents were collated. Time of administration was stratified as phase 1 recovery (0-6 hours) and observation (6-24 hours). Logistic regression model was used to investigate the relationship of transarterial chemoembolization type and use of intravenous and/or oral analgesic and antiemetic medications while controlling for other clinical variables. RESULTS More patients treated with DEE-transarterial chemoembolization required intravenous analgesia in the observation (6-24 hours) phase (18.5%) than those treated with c-transarterial chemoembolization (10.6%; P = .033). Similar results were noted for oral analgesic agents (50.2% vs. 31.4%, respectively; P < .001) and antiemetics (17.1% vs. 7.5%, respectively; P = .006) during the observation period. Multivariate regression models identified DEE-transarterial chemoembolization as an independent predictor for oral analgesia (odds ratio [OR], 1.84; P = .011), for intravenous and oral analgesia in opioid-naïve patients (OR, 2.46; P = .029) and for antiemetics (OR, 2.56; P = .011). CONCLUSIONS Compared to c-transarterial chemoembolization, DEE-transarterial chemoembolization required greater amounts of opioid analgesic and antiemetic agents 6-24 hours after the procedure. Surgical data indicate that a persistent opioid habit can develop even after minor surgeries, therefore, caution should be exercised, and a regimen of nonopiate pain medications should be considered to reduce postprocedural pain after transarterial chemoembolization.
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Affiliation(s)
| | - Rajesh P Shah
- Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Victoria Green
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | | | - Tie Liang
- Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Nishita Kothary
- Department of Radiology, Stanford University School of Medicine, Stanford, California.
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Xu W, Ding Z, Shan Y, Chen W, Feng Z, Pang P, Shen Q. A Nomogram Model of Radiomics and Satellite Sign Number as Imaging Predictor for Intracranial Hematoma Expansion. Front Neurosci 2020; 14:491. [PMID: 32581674 PMCID: PMC7287169 DOI: 10.3389/fnins.2020.00491] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 04/20/2020] [Indexed: 12/21/2022] Open
Abstract
Background We aimed to construct and validate a nomogram model based on the combination of radiomic features and satellite sign number for predicting intracerebral hematoma expansion. Methods A total of 129 patients from two institutions were enrolled in this study. The preprocessed initial CT images were used for radiomic feature extraction. The ANOVA-Kruskal–Wallis test and least absolute shrinkage and selection operator regression were applied to identify candidate radiomic features and construct the Radscore. A nomogram model was developed by integrating the Radscore with a satellite sign number. The discrimination performance of the proposed model was evaluated by receiver operating characteristic (ROC) analysis, and the predictive accuracy was assessed via a calibration curve. Decision curve analysis (DCA) and Kaplan–Meier (KM) survival analysis were performed to evaluate the clinical value of the model. Results Four optimal features were ultimately selected and contributed to the Radscore construction. A positive correlation was observed between the satellite sign number and Radscore (Pearson’s r: 0.451). The nomogram model showed the best performance with high area under the curves in both training cohort (0.881, sensitivity: 0.973; specificity: 0.787) and external validation cohort (0.857, sensitivity: 0.950; specificity: 0.766). The calibration curve, DCA, and KM analysis indicated the high accuracy and clinical usefulness of the nomogram model for hematoma expansion prediction. Conclusion A nomogram model of integrated radiomic signature and satellite sign number based on noncontrast CT images could serve as a reliable and convenient measurement of hematoma expansion prediction.
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Affiliation(s)
- Wen Xu
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhongxiang Ding
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanna Shan
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenhui Chen
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhan Feng
- Department of Radiology, The First Hospital of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Peipei Pang
- Department of Pharmaceuticals Diagnosis, GE Healthcare, Hangzhou, China
| | - Qijun Shen
- Department of Radiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Zhu Y, Li X, Ma J, Xu W, Li M, Gong Y, Zhang B, Chen Y, Chao S, Xu Q, Lin L, Chen JDZ. Transcutaneous Electrical Acustimulation Improves Gastrointestinal Disturbances Induced by Transcatheter Arterial Chemoembolization in Patients With Liver Cancers. Neuromodulation 2020; 23:1180-1188. [PMID: 32378261 DOI: 10.1111/ner.13158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 03/15/2020] [Accepted: 03/15/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Gastrointestinal (GI) disturbances occur in patients who receive chemotherapy via transcatheter arterial chemoembolization (TACE) and could last for an extended period of time in some cases. Antiemetic drugs have a potential risk of developing hepatic failure and are ineffective for delayed nausea and emesis. Transcutaneous electrical acustimulation (TEA) has recently been reported to exert antiemetic and prokinetic effects, but it is unknown whether it has an ameliorating effect on TACE-induced GI disturbances. AIM This study was designed to evaluate effects and mechanisms of noninvasive TEA on GI symptoms in patients treated with TACE. MATERIALS AND METHODS Seventy-four patients with liver cancers (eighteen female; age 63.4 ± 1.1 years) scheduled for TACE were randomized to TEA (n = 37) or sham-TEA (n = 37). TEA was performed via acupoints, ST36 and PC6 using parameters previously optimized for GI motility (1 h, bid) from the postoperative day 0 (POD0) to POD2. Sham-TEA was performed using the same parameters via non-acupoints. Symptom questionnaires were completed daily. The electrogastrogram (EGG) and electrocardiogram (ECG) were recorded in the fasting state for 30 mins to assess gastric slow waves and autonomic functions, respectively, before and after the 3-day treatment. RESULTS 1) In the acute phase (<24 h), TEA showed no effects on any of GI symptoms, compared with sham-TEA. 2) In the delayed phase (>24 h), TEA, compared with sham-TEA, decreased the percentage of patients who experienced nausea on POD3 (0% vs. 13.5%, p = 0.021), the nausea score on POD3 (p = 0.022), the anorexia score on POD2 (p = 0.040) and POD3 (p = 0.004), and the bloating score (POD1-3: p < 0.01). 3) In comparison with sham-TEA, TEA increased the number of spontaneous bowel movements (p = 0.001) and the Bristol score of the first stool (p = 0.014) and decreased the number of patients with the use of laxatives (p = 0.022). 4) Physiologically, the 3-day TEA but not sham-TEA increased the percentage of normal gastric slow waves (p < 0.001) and vagal activity (p = 0.006). The vagal activity was negatively correlated with the anorexia score (r = -0.267, p = 0.026). It was found that the sympathovagal ratio and tumor size>5 cm were independent risk factors predicting the occurrence of nausea in patients after TACE. CONCLUSION TEA improves major TACE-induced GI disturbances in the delayed phase, including nausea, bloating, impaired gastric pace-making activity, and constipation in patients with liver cancers via the autonomic pathway.
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Affiliation(s)
- Ying Zhu
- Division of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,Division of Gastroenterology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Xianpeng Li
- Division of Infectious Disease, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, China
| | - Jibo Ma
- Division of Intervention, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, China
| | - Wenyi Xu
- Division of Intervention, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, China
| | - Miaomiao Li
- Division of Gastroenterology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Yaoyao Gong
- Division of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Bo Zhang
- Division of Infectious Disease, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, China
| | - Ying Chen
- Division of Infectious Disease, Yinzhou Hospital Affiliated to Medical School of Ningbo University, Ningbo, China
| | - Sun Chao
- Division of Gastroenterology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Qingcheng Xu
- Division of Gastroenterology, Northern Jiangsu People's Hospital, Yangzhou, China
| | - Lin Lin
- Division of Gastroenterology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiande D Z Chen
- Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, USA
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Wang TC, Zhang ZS, Xiao YD. Determination of Risk Factors for Pain After Transarterial Chemoembolization with Drug-Eluting Beads for Hepatocellular Carcinoma. J Pain Res 2020; 13:649-656. [PMID: 32273750 PMCID: PMC7108874 DOI: 10.2147/jpr.s246197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/06/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose To identify risk factors for pain after transarterial chemoembolization with drug-eluting beads (DEB-TACE) for hepatocellular carcinoma (HCC). Patients and Methods In this retrospective study, a total of 118 consecutive patients who underwent DEB-TACE between June 2016 and May 2019 with post-TACE pain were included. The patients were divided into three groups based on the severity of post-TACE pain according to the distribution of pain Visual Analogue Scale/Score (VAS). Potential risk factors for post-TACE pain were primarily analyzed using the chi-square test, one-way analysis of variance, or Kruskal–Wallis test (if appropriate). For multivariate analysis, an ordinal logistic regression model was utilized. Variables with P<0.10 in the univariate analysis were included in a multivariate model to identify independent risk factors for post-TACE pain. A multivariate analysis was also performed by means of a decision tree using the Classification and Regression Tree (CART) algorithm. Results The univariate analysis showed that elderly patients or patients with portal venous tumor thrombus (PVTT) were more likely to have severe post-TACE pain than young patients or those without PVTT (P=0.028 and <0.001, respectively). However, in the ordinal logistic regression, nonsuperselective chemoembolization and presence of PVTT were independent risk factors of severe post-TACE pain (P=0.046 and <0.001, respectively). In addition, the CART showed that nonsuperselective chemoembolization and PVTT could increase the probability of severe post-TACE pain. Conclusion Nonsuperselective chemoembolization and PVTT are independent risk factors for pain after DEB-TACE. Therefore, these factors should be taken into full consideration for the relief of pain.
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Affiliation(s)
- Tian-Cheng Wang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Zi-Shu Zhang
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Yu-Dong Xiao
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
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