|
1
|
Cadar R, Lupascu Ursulescu C, Vasilescu AM, Trofin AM, Zabara M, Rusu-Andriesi D, Ciuntu B, Muzica C, Lupascu CD. Challenges and Solutions in the Management of Hepatocellular Carcinoma Associated with Non-Alcoholic Fatty Liver Disease. Life (Basel) 2023; 13:1987. [PMID: 37895369 PMCID: PMC10608140 DOI: 10.3390/life13101987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/28/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) has gained attention in the last few years due to its increasing prevalence worldwide becoming a global epidemic. The increasing incidence of NAFLD and the concurrent increase in the number of hepatocellular carcinoma (HCC) cases at a global level is a matter of concern. HCC has several risk factors, of which NAFLD and its associated metabolic disturbances-type 2 diabetes mellitus, obesity, and dyslipidemia-are of great interest due to their accelerating rise in incidence worldwide. There is a high amount of data derived from basic and clinical studies that reveal the molecular pathways that drive NAFLD-associated HCC. Based on these findings, new prevention, surveillance, and treatment strategies are emerging. However, current data on treatment modalities in NAFLD-associated HCC are still scarce, though the results from non-NAFLD HCC studies are promising and could provide a basis for a future research agenda to address NAFLD/NASH patients. Clinicians should carefully assess all the clinical and radiological parameters and establish a prognosis based on the Barcelona Clinic Liver Cancer classification and discuss in a multidisciplinary team the treatment strategy. The specific factors associated with NAFLD-associated HCC which can have a negative impact on survival even in patients with early HCC, such as cardiovascular disease, type 2 diabetes, and obesity, should be taken into consideration. This review aims to discuss the latest recommendations regarding the diagnosis and treatment of NAFLD-associated HCC and the remaining challenges.
Collapse
Affiliation(s)
- Ramona Cadar
- Department of Surgery, Gr. T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (R.C.); (A.M.T.); (M.Z.); (B.C.); (C.D.L.)
- General Surgery and Liver Transplant Clinic, St. Spiridon University Hospital, 700111 Iasi, Romania
| | - Corina Lupascu Ursulescu
- Department of Radiology, Gr. T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania;
- Radiology Clinic, St. Spiridon University Hospital, 700111 Iasi, Romania
| | - Alin Mihai Vasilescu
- Department of Surgery, Gr. T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (R.C.); (A.M.T.); (M.Z.); (B.C.); (C.D.L.)
- General Surgery and Liver Transplant Clinic, St. Spiridon University Hospital, 700111 Iasi, Romania
| | - Ana Maria Trofin
- Department of Surgery, Gr. T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (R.C.); (A.M.T.); (M.Z.); (B.C.); (C.D.L.)
- General Surgery and Liver Transplant Clinic, St. Spiridon University Hospital, 700111 Iasi, Romania
| | - Mihai Zabara
- Department of Surgery, Gr. T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (R.C.); (A.M.T.); (M.Z.); (B.C.); (C.D.L.)
- General Surgery and Liver Transplant Clinic, St. Spiridon University Hospital, 700111 Iasi, Romania
| | - Delia Rusu-Andriesi
- Department of Surgery, Gr. T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (R.C.); (A.M.T.); (M.Z.); (B.C.); (C.D.L.)
- General Surgery and Liver Transplant Clinic, St. Spiridon University Hospital, 700111 Iasi, Romania
| | - Bogdan Ciuntu
- Department of Surgery, Gr. T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (R.C.); (A.M.T.); (M.Z.); (B.C.); (C.D.L.)
- General Surgery and Liver Transplant Clinic, St. Spiridon University Hospital, 700111 Iasi, Romania
| | - Cristina Muzica
- Department of Gastroenterology, Gr. T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
- Institute of Gastroenterology and Hepatology, St. Spiridon University Hospital, 700111 Iasi, Romania
| | - Cristian Dumitru Lupascu
- Department of Surgery, Gr. T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania; (R.C.); (A.M.T.); (M.Z.); (B.C.); (C.D.L.)
- General Surgery and Liver Transplant Clinic, St. Spiridon University Hospital, 700111 Iasi, Romania
| |
Collapse
|
|
2
|
Liu CY, Cheng CY, Yang SY, Chai JW, Chen WH, Chang PY. Mortality Evaluation and Life Expectancy Prediction of Patients with Hepatocellular Carcinoma with Data Mining. Healthcare (Basel) 2023; 11:healthcare11060925. [PMID: 36981582 PMCID: PMC10048888 DOI: 10.3390/healthcare11060925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The complexity of systemic variables and comorbidities makes it difficult to determine the best treatment for patients with hepatocellular carcinoma (HCC). It is impossible to perform a multidimensional evaluation of every patient, but the development of guidelines based on analyses of said complexities would be the next best option. Whereas conventional statistics are often inadequate for developing multivariate predictive models, data mining has proven more capable. Patients, methods and findings: Clinical profiles and treatment responses of 537 patients diagnosed with Barcelona Clinic Liver Cancer stages B and C from 2009 to 2019 were retrospectively analyzed using 4 decision tree algorithms. A combination of 19 treatments, 7 biomarkers, and 4 states of hepatitis was tested to determine which combinations would result in survival times greater than a year in duration. Just 2 of the algorithms produced complete models through single trees, which made them only the ones suitable for clinical judgement. A combination of alpha fetoprotein ≤210.5 mcg/L, glutamic oxaloacetic transaminase ≤1.13 µkat/L, and total bilirubin ≤ 0.0283 mmol/L was shown to be a good predictor of survival >1 year, and the most effective treatments for such patients were radio-frequency ablation (RFA) and transarterial chemoembolization (TACE) with radiation therapy (RT). In patients without this combination, the best treatments were RFA, TACE with RT and targeted drug therapy, and TACE with targeted drug therapy and immunotherapy. The main limitation of this study was its small sample. With a small sample size, we may have developed a less reliable model system, failing to produce any clinically important results or outcomes. CONCLUSION Data mining can produce models to help clinicians predict survival time at the time of initial HCC diagnosis and then choose the most suitable treatment.
Collapse
Affiliation(s)
- Che-Yu Liu
- Department of Radiology, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Chen-Yang Cheng
- Department of Industrial Engineering and Management, National Taipei University of Technology, Taipei 106, Taiwan
| | - Szu-Ying Yang
- Nursing Department, Taichung Veterans General Hospital, Taichung 407, Taiwan
| | - Jyh-Wen Chai
- Department of Radiology, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Section of Radiology, College of Medicine, China Medical University, Taichung 404, Taiwan
- College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
| | - Wei-Hao Chen
- Institute of Business & Management, National Yang Ming Chiao Tung University, Taipei 100, Taiwan
| | - Pi-Yi Chang
- Department of Radiology, Taichung Veterans General Hospital, Taichung 407, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 407, Taiwan
| |
Collapse
|
|
3
|
Tsuchiya S, Saiga A, Yokota H, Kubota Y, Wada T, Akutsu A, Koizumi J, Aramaki T, Uno T. Prophylactic Steroids for Preventing Postembolization Syndrome after Transcatheter Arterial Embolization of Renal Angiomyolipoma: A Comparative Study. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2023; 8:1-6. [PMID: 36936258 PMCID: PMC10017270 DOI: 10.22575/interventionalradiology.2021-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/19/2022] [Indexed: 03/06/2023]
Abstract
Purpose Postembolization syndrome (PES) after renal arterial embolization (RAE) can reduce the patient's tolerance of the procedure and extend the length of hospital stay. We aimed to assess the efficacy of steroid administration in preventing PES in patients undergoing RAE for angiomyolipoma (AML). Material and Methods Between May 2004 and March 2020, 29 RAE procedures in 26 patients with AML were performed. Patient information, including age, sex, tumor size, tuberous sclerosis complex-associated/sporadic AML, hemorrhagic/nonhemorrhagic AML, embolic material, steroid use, medication type, some blood laboratory parameters, hospital stay, and PES occurrence were retrospectively obtained. The prophylactic steroid protocol used in the study was as follows: 250 mg of intravenous methylprednisolone (Solu-Medrol) 2 h before the RAE procedure, followed by 2 days of intravenous prednisolone (Predonine; 2 mg/kg/day), which was tapered by halving the dose every 2 days within the course of 2 weeks. After the discharge, intravenous prednisolone was changed to oral prednisolone (Predonine). PES was defined as the presence of fever, pain, nausea, or vomiting. Data were compared between the steroid and non-steroid groups and between PES and non-PES groups. Results The PES incidence rate was 76%, and a comparison between the steroid and non-steroid groups revealed that steroid use significantly decreased the incidence of PES (P < 0.001), including fever (P < 0.001), pain (P = 0.005), and nausea (P = 0.028). The use of anti-inflammatory drugs during the hospital stay was significantly lower in the steroid group (P = 0.019). Moreover, in the steroid group, C-reactive protein level was significantly lower (P = 0.006), whereas white blood cell count was significantly higher (P = 0.004). Conversely, the median length of hospital stay was not significantly shorter in the steroid group (P = 0.292). Conclusions The prophylactic use of steroids before and after embolization of renal AML may be effective in preventing PES in this small retrospective study.
Collapse
Affiliation(s)
- Satoshi Tsuchiya
- Division of Interventional Radiology, Shizuoka Cancer Center, Japan
- Department of Radiology, Chiba University Hospital, Japan
| | - Atsushi Saiga
- Division of Interventional Radiology, Shizuoka Cancer Center, Japan
- Department of Radiology, Chiba University Hospital, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Chiba University Graduate School of Medicine, Japan
| | | | - Takeshi Wada
- Department of Radiology, Chiba University Hospital, Japan
| | - Akira Akutsu
- Department of Radiology, Chiba University Hospital, Japan
| | - Jun Koizumi
- Department of Radiology, Chiba University Hospital, Japan
| | - Takeshi Aramaki
- Division of Interventional Radiology, Shizuoka Cancer Center, Japan
| | - Takashi Uno
- Department of Diagnostic Radiology and Radiation Oncology, Chiba University Graduate School of Medicine, Japan
| |
Collapse
|
|
4
|
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: 8] [Impact Index Per Article: 4.0] [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.
Collapse
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.
| |
Collapse
|
|
5
|
Kim MS, Kang M, Park J, Ryu JM. Nurses' comfort care of transarterial chemoembolization patients based on their perceptions around postembolization syndrome and symptom interference. Nurs Open 2022; 10:2877-2885. [PMID: 36565057 PMCID: PMC10077417 DOI: 10.1002/nop2.1529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 10/03/2022] [Accepted: 11/20/2022] [Indexed: 12/25/2022] Open
Abstract
AIM Post-embolization syndrome is a common adverse event following trans-arterial chemoembolization, which negatively impacts the daily life of the patients involved. This study examined whether perceptions around post-embolization syndrome and symptom interference among nurses affect their comfort care performance toward patients who have undergone this procedure. DESIGN A descriptive cross-sectional study. METHODS One hundred and fifty registered nurses were surveyed from September to November 2020. Perceived post-embolization syndrome, symptom interference, and comfort care (including physical, psychospiritual, sociocultural, and environmental dimensions) were measured. Data were analyzed using t-tests, analysis of variance, Pearson's correlation, and a multivariate analysis of variance. RESULTS There were no individual effects found of perceived post-embolization syndrome or symptom interference on nurses' comfort care performance. However, statistically significant interaction effects were found in terms of their sociocultural and environmental care. CONCLUSION Nurses who recognized both high post-embolization syndrome and symptom interference among their patients were found to provide greater sociocultural and environmental care. As such, nurses should improve their early symptom and symptom interference detection protocols based on current care guidelines and provide physical, psychospiritual, sociocultural, and environmental comfort care.
Collapse
Affiliation(s)
- Myoung Soo Kim
- Department of Nursing, Pukyong National University, Busan, South Korea
| | - Minkyeong Kang
- Department of Nursing, Pukyong National University, Busan, South Korea
| | - Jiwon Park
- Department of Nursing, Pukyong National University, Busan, South Korea
| | - Jung Mi Ryu
- Department of Nursing, Busan Institute of Science and Technology, Busan, South Korea
| |
Collapse
|
|
6
|
Yuan M, Chen TY, Chen XR, Lu YF, Shi J, Zhang WS, Ye C, Tang BZ, Yang ZG. Identification of predictive factors for post-transarterial chemoembolization liver failure in hepatocellular carcinoma patients: A retrospective study. World J Clin Cases 2022; 10:8535-8546. [PMID: 36157824 PMCID: PMC9453355 DOI: 10.12998/wjcc.v10.i24.8535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/09/2022] [Accepted: 07/17/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Post-transarterial chemoembolization (TACE) liver failure occurs frequently in hepatocellular carcinoma (HCC) patients. The identification of predictors for post-TACE liver failure is of great importance for clinical decision-making in this population.
AIM To investigate the occurrence rate and predictive factors of post-TACE liver failure in this retrospective study to provide clues for decision-making regarding TACE procedures in HCC patients.
METHODS The clinical records of HCC patients treated with TACE therapy were reviewed. Baseline clinical characteristics and laboratory parameters of these patients were extracted. Logistic models were used to identify candidates to predict post-TACE liver failure.
RESULTS A total of 199 HCC patients were enrolled in this study, and 70 patients (35.2%) developed post-TACE liver failure. Univariate and multivariate logistic models indicated that microspheres plus gelatin embolization and main tumor size > 5 cm were risk predictors for post-TACE liver failure [odds ratio (OR): 4.4, 95% confidence interval (CI): 1.2-16.3, P = 0.027; OR: 2.3, 95%CI: 1.05-5.3, P = 0.039, respectively]. Conversely, HCC patients who underwent tumor resection surgery before the TACE procedure had a lower risk for post-TACE liver failure (OR: 0.4, 95%CI: 0.2-0.95, P = 0.039).
CONCLUSION Microspheres plus gelatin embolization and main tumor size might be risk factors for post-TACE liver failure in HCC patients, while prior tumor resection could be a favorable factor reducing the risk of post-TACE liver failure.
Collapse
Affiliation(s)
- Min Yuan
- Department of Interventional Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Tian-You Chen
- Department of Interventional Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Xiao-Rong Chen
- Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Yun-Fei Lu
- Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Jia Shi
- Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Wen-Si Zhang
- Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Chen Ye
- Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Bo-Zong Tang
- Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
- Department of Internal Medicine of Traditional Chinese Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 201200, China
| | - Zong-Guo Yang
- Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| |
Collapse
|
|
7
|
Foerster F, Gairing SJ, Müller L, Galle PR. NAFLD-driven HCC: Safety and efficacy of current and emerging treatment options. J Hepatol 2022; 76:446-457. [PMID: 34555422 DOI: 10.1016/j.jhep.2021.09.007] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/17/2021] [Accepted: 09/09/2021] [Indexed: 12/11/2022]
Abstract
In light of a global rise in obesity and type 2 diabetes, non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) represent an increasingly important underlying aetiology of hepatocellular carcinoma (HCC). HCCs arising from lipotoxicity-mediated chronic inflammation are characterised by several unique features: in contrast to virally driven HCC, up to 50% of NAFLD-HCC occurs in patients without cirrhosis and annual HCC incidence is comparatively low, complicating current surveillance strategies. On average, patients are older and are more frequently diagnosed at an advanced stage. While locoregional treatments are probably equally effective regardless of HCC aetiology, the picture is less clear for systemic therapy. Tyrosine kinase inhibitors are probably equally effective, while there have been initial signals that immune checkpoint inhibitors may be less effective in NAFLD-HCC than in viral HCC. Current international clinical practice guidelines for HCC do not consider aetiology, as there are insufficient data to draw specific conclusions or to recommend aetiology-specific modifications to the current management of patients with HCC. However, in light of the growing relevance of NAFLD-HCC, future clinical trials should assess whether HCC aetiology - and NAFLD/NASH in particular - influence the safety and efficacy of a given treatment.
Collapse
Affiliation(s)
- Friedrich Foerster
- Department of Medicine I, University Medical Center of the Johannes-Gutenberg University Mainz, Germany
| | - Simon Johannes Gairing
- Department of Medicine I, 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
| | - Peter Robert Galle
- Department of Medicine I, University Medical Center of the Johannes-Gutenberg University Mainz, Germany.
| |
Collapse
|
|
8
|
Chi CT, Lee IC, Lee RC, Hung YW, Su CW, Hou MC, Chao Y, Huang YH. Effect of Transarterial Chemoembolization on ALBI Grade in Intermediate-Stage Hepatocellular Carcinoma: Criteria for Unsuitable Cases Selection. Cancers (Basel) 2021; 13:4325. [PMID: 34503135 PMCID: PMC8431519 DOI: 10.3390/cancers13174325] [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: 07/21/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 02/08/2023] Open
Abstract
Transarterial chemoembolization (TACE) is the standard of care for intermediate stage hepatocellular carcinoma (HCC). We aimed to identify unsuitable cases who were at risk of ALBI-grade migration by TACE. Consecutive 531 BCLC-B HCC patients undergoing TACE were reviewed, and factors associated with ALBI-grade migration were analyzed. There were 129 (24.3%) patients experienced acute ALBI-grade migration after TACE, and 85 (65.9%) out of the 129 patients had chronic ALBI-grade migration. Incidences of acute ALBI-grade migration were 13.9%, 29.0% for patients within or beyond up-to-7 criteria (p < 0.001) and 20.0%, 36.2% for patients within or beyond up-to-11 criteria (p < 0.001), respectively. HBV infection, tumor size plus tumor number criteria were risk factors associated with acute ALBI-grade migration. Bilobar tumor involvement was the risk factor of chronic ALBI-grade migration in patients with acute ALBI-grade migration. Up-to-eleven (p = 0.007) performed better than up-to-seven (p = 0.146) to differentiate risk of dynamic ALBI score changes. Moreover, ALBI-grade migration to grade 3 has adverse effect on survival. In conclusion, tumor burden beyond up-to-eleven was associated with ALBI-grade migration after TACE, indicating that up-to-eleven can select TACE-unsuitable HCC patients who are at risk of liver function deterioration.
Collapse
Affiliation(s)
- Chen-Ta Chi
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-T.C.); (I.-C.L.); (Y.-W.H.); (C.-W.S.); (M.-C.H.)
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - I-Cheng Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-T.C.); (I.-C.L.); (Y.-W.H.); (C.-W.S.); (M.-C.H.)
| | - Rheun-Chuan Lee
- Department of Radiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
| | - Ya-Wen Hung
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-T.C.); (I.-C.L.); (Y.-W.H.); (C.-W.S.); (M.-C.H.)
| | - Chien-Wei Su
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-T.C.); (I.-C.L.); (Y.-W.H.); (C.-W.S.); (M.-C.H.)
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-T.C.); (I.-C.L.); (Y.-W.H.); (C.-W.S.); (M.-C.H.)
| | - Yee Chao
- Department of Oncology, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (C.-T.C.); (I.-C.L.); (Y.-W.H.); (C.-W.S.); (M.-C.H.)
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| |
Collapse
|
|
9
|
Role of N-acetyl Cysteine in Post-transarterial Chemoembolization Transaminitis in Hepatocellular Carcinoma: A Single-center Experience. J Clin Exp Hepatol 2021; 11:299-304. [PMID: 33994712 PMCID: PMC8103334 DOI: 10.1016/j.jceh.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Transarterial chemoembolization (TACE) is the most common locoregional therapy for hepatocellular carcinoma (HCC). Postembolization syndrome is not an uncommon complication. At present, there is no specific treatment for management of this complication. We aimed to study the role of N-acetyl cysteine (NAC), an antioxidant, in management of this complication. METHODS In a prospective observational study, consecutive patients with HCC undergoing TACE from January 2016 to January 2017 were included. Patients with postembolization syndrome, defined as an elevation of transaminase levels more than 3-4 times the upper limit of normal, were administered intravenous NAC for 72 h (150 mg/kg for 1 h, then 12.5 mg/kg/h for 4 h, and continuous infusion 6.25 mg/h for the remaining 67 h). The other group received only supportive standard of care. The primary end point was reduction in post-TACE transaminitis. RESULTS Of 112 patients with HCC, 53 (47.3%) received NAC. The majority were cirrhotics in both the groups. Both groups were well matched in demographic, laboratory, and tumor characteristics. In the NAC group, there was significant reduction in Aspartate transaminase (AST) and Alanine transaminase (ALT) levels from day 1 to day 3 (p = 0.000) compared with the non-NAC group, with no significant change in bilirubin or international normalized ratio levels. The duration of hospital stay was similar in both the groups. None had any major adverse events to NAC. CONCLUSION This is a prospective, single-center experience, showing that early initiation of N-acetyl cysteine in those with post-TACE embolization syndrome reduces the transaminase level significantly.
Collapse
Key Words
- AFP, alpha-fetoprotein
- ANOVA, analysis of variance
- BCLC, Barcelona Clinic Liver Cancer
- CT, computed tomography
- HCC, hepatocellular carcinoma
- IL, interleukin
- INR, international normalized ratio
- LT, liver transplantation
- NAC, N-acetyl cysteine
- PES, postembolization syndrome
- TACE, Transarterial chemoembolization
- chronic liver disease
- liver cancer
- liver transplant
Collapse
|
|
10
|
Reichert MC, Massmann A, Schulz A, Buecker A, Glanemann M, Lammert F, Malinowski M. Volume-Function Analysis (LiMAx Test) in Patients with HCC and Cirrhosis Undergoing TACE-A Feasibility Study. Dig Dis Sci 2021; 66:2452-2460. [PMID: 32816218 PMCID: PMC8236026 DOI: 10.1007/s10620-020-06535-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/03/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transarterial chemoembolization (TACE) is an important therapy for hepatocellular carcinoma (HCC) in cirrhosis. In particular in advanced cirrhosis, post-TACE hepatic failure liver (PTHF) failure may develop. Currently, there is no standardization for the periinterventional risk assessment. The liver maximum capacity (LiMAx) test assesses the functional liver capacity, but has not been investigated in this setting. AIMS The aim of this study was to prospectively evaluate periinterventional LiMAx and CT volumetry measurements in patients with cirrhosis and HCC undergoing repetitive TACE. METHODS From 06/2016 to 11/2017, eleven patients with HCC and cirrhosis undergoing TACE were included. LiMAx measurements (n = 42) were conducted before and after each TACE. Laboratory parameters were correlated with the volume-function data. RESULTS The median LiMAx levels before (276 ± 166 µg/kg/h) were slightly reduced after TACE (251 ± 122 µg/kg/h; p = 0.08). This corresponded to a median drop of 7.1%. Notably, there was a significant correlation between LiMAx levels before TACE and bilirubin (but not albumin nor albumin-bilirubin [ALBI] score) increase after TACE (p = 0.02, k = 0.56). Furthermore, a significantly higher increase in bilirubin in patients with LiMAx ≤ 150 µg/kg/h was observed (p = 0.011). LiMAx levels at different time points in single patients were similar (p = 0.2). CONCLUSION In our prospective pilot study in patients with HCC and cirrhosis undergoing multiple TACE, robust and reliable LiMAx measurements were demonstrated. Lower LiMAx levels before TACE were associated with surrogate markers (bilirubin) of liver failure after TACE. Specific subgroups at high risk of PTHF should be investigated. This might facilitate the future development of strategies to prevent occurrence of PTHF.
Collapse
Affiliation(s)
| | - Alexander Massmann
- Department for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany
| | - Antje Schulz
- Department of General, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Kirrberger Str. 100, 66424, Homburg, Germany
| | - Arno Buecker
- Department for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Germany
| | - Matthias Glanemann
- Department of General, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Kirrberger Str. 100, 66424, Homburg, Germany
| | - Frank Lammert
- Department of Medicine II, Saarland University Medical Center, Homburg, Germany
| | - Maciej Malinowski
- Department of General, Visceral, Vascular and Pediatric Surgery, Saarland University Medical Center, Kirrberger Str. 100, 66424, Homburg, Germany.
| |
Collapse
|
|
11
|
Arslan M, Degirmencioglu S. Risk Factors for Postembolization Syndrome After Transcatheter Arterial Chemoembolization. Curr Med Imaging 2020; 15:380-385. [PMID: 31989907 DOI: 10.2174/1573405615666181122145330] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 11/04/2018] [Accepted: 11/10/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Transarterial Chemoembolization (TACE) is a minimally invasive treatment in managing unresectable liver primary neoplasms or liver metastases. Postembolization Syndrome (PES) is the most common adverse effect after TACE procedures. OBJECTIVE We investigate the risk factors for the development of PES after TACE therapy in patients with primary or metastatic liver tumors. METHODS In a retrospective analysis of 163 patients who underwent TACE between 01/01/2012 and 31/01/2018, patients that were given medication due to pain, fever, nausea or vomiting were evaluated and noted with PES. Analyses were made to evaluate factors such as age, gender, chemotherapy agent and dose, tumor size, tumor type, a particle used for embolization, multiple tumor treatments and selective application of the procedure, which may lead to PES after TACE. RESULTS In a total of 316 patients, PES was observed at a rate of 55 percent after TACE. Tumor size, number of tumors treated and adopting super selective fashion in the procedure were found to be related to the development of PES. No relationship was found between age, gender, presence of ascites, tumor type, size of embolic agent and drug type and the development of PES. CONCLUSION A treated tumor measuring >5 cm, treating more than one tumor, and the failure to perform the procedure in a super selective fashion increase the risk of PES development after TACE.
Collapse
Affiliation(s)
- Muhammet Arslan
- Department of Radiology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | | |
Collapse
|
|
12
|
Peng C, Teng W, Hsieh Y, Jeng W, Huang C, Lui K, Hung C, Chen Y, Lin C, Lin C, Lin S, Sheen I. Postembolization fever after transarterial chemoembolization is a sign of unfavorable therapeutic response in hepatocellular carcinoma patients. ADVANCES IN DIGESTIVE MEDICINE 2020. [DOI: 10.1002/aid2.13182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Chien‐Wei Peng
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| | - Wei Teng
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| | - Yi‐Chung Hsieh
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| | - Wen‐Juei Jeng
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| | - Chien‐Hao Huang
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| | - Kar‐Wai Lui
- College of Medicine, Chang Gung University Taipei Taiwan
- Department of RadiologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
| | - Chen‐Fu Hung
- College of Medicine, Chang Gung University Taipei Taiwan
- Department of RadiologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
| | - Yi‐Cheng Chen
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| | - Chen‐Chun Lin
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| | - Chun‐Yen Lin
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| | - Shi‐Ming Lin
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| | - I‐Shyan Sheen
- Department of Gastroenterology and HepatologyChang Gung Memorial Hospital, Linkou Branch Taoyuan Taiwan
- College of Medicine, Chang Gung University Taipei Taiwan
| |
Collapse
|
|
13
|
Young S, Sanghvi T, Rubin N, Hall D, Roller L, Charaf Y, Golzarian J. Transarterial Chemoembolization of Hepatocellular Carcinoma: Propensity Score Matching Study Comparing Survival and Complications in Patients with Nonalcoholic Steatohepatitis Versus Other Causes Cirrhosis. Cardiovasc Intervent Radiol 2019; 43:65-75. [PMID: 31686136 DOI: 10.1007/s00270-019-02363-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/21/2019] [Indexed: 01/06/2023]
Abstract
PURPOSE To evaluate the oncologic outcomes and complication profile in nonalcoholic steatohepatitis (NASH)-induced cirrhosis leading to hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). MATERIALS AND METHODS Two hundred and twenty patients who underwent treatment of 353 HCCs were retrospectively reviewed, including 30 NASH patients who received TACE for 46 HCCs. Patient charts were evaluated for time to progression (TTP), complications and overall survival (OS). The group was split into NASH and non-NASH cohorts for comparison and additional analyses were done using propensity score matching (PSM). RESULTS Patients in the NASH cohort presented with significantly larger lesions (4.9 ± 5.8 cm vs 3.1 ± 2.4 cm, p = 0.05). There was no significant difference in TTP overall [Median NASH 396 days (95% CI 308-526 days) vs non-NASH cohort 307 days (95% CI 272-364), p = 0.25) or after PSM [259 days non-NASH (95% CI 215-490) vs 396 days NASH (95% CI (349-not reached), p = 0.43]. There was a non-significant increased OS in the non-NASH [median 1078 days (95% CI 668-1594)] as compared to the NASH cohort [median 706 days (95% CI 314-not reached)] (p = 0.08) which decreased following PSM [853 days (95% CI 526-1511) non-NASH vs 706 days (95% CI 314-not reached) NASH, p = 0.48]. The number of complications did not differ significantly between the two groups (p = 0.23). CONCLUSION The oncologic outcomes and complication profile of TACE for HCC induced by NASH cirrhosis appear to be similar to that of other etiologies of cirrhosis. NASH patients presented with larger tumors emphasizing the need for early surveillance.
Collapse
Affiliation(s)
- Shamar Young
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delaware St SE MMC 292, Minneapolis, MN, 55455, USA.
| | - Tina Sanghvi
- VA Department of Radiology, Minneapolis VA Health Care System, 1 Veterans Dr, Minneapolis, MN, 55417, USA
| | - Nathan Rubin
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delaware St SE MMC 292, Minneapolis, MN, 55455, USA
| | - Damian Hall
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delaware St SE MMC 292, Minneapolis, MN, 55455, USA
| | - Luke Roller
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delaware St SE MMC 292, Minneapolis, MN, 55455, USA
| | - Yassine Charaf
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delaware St SE MMC 292, Minneapolis, MN, 55455, USA
| | - Jafar Golzarian
- Department of Radiology, Division of Interventional Radiology, University of Minnesota, 420 Delaware St SE MMC 292, Minneapolis, MN, 55455, USA
| |
Collapse
|
|
14
|
Aoe M, Kanemitsu T, Ohki T, Kishi S, Ogura Y, Takenaka Y, Hashiba T, Ambe H, Furukawa E, Kurata Y, Ichikawa M, Ohara K, Honda T, Furuse S, Saito K, Toda N, Mise N. Incidence and risk factors of contrast-induced nephropathy after transcatheter arterial chemoembolization in hepatocellular carcinoma. Clin Exp Nephrol 2019; 23:1141-1146. [DOI: 10.1007/s10157-019-01751-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 05/20/2019] [Indexed: 12/15/2022]
|
|
15
|
Wang ZX, Li L, Tao FY. Health education helps to relieve postembolization pain during hepatic arterial chemoembolization therapy. J Pain Res 2018; 11:2115-2121. [PMID: 30319286 PMCID: PMC6169766 DOI: 10.2147/jpr.s166333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Aim Psychological intervention has been proved a complementary approach to drug analgesia. Another study suggested that health knowledge is associated with psychological symptoms in patients with liver cancer. This study is conducted to assess whether improving the health education (HE) alleviates the postembolization pain during transarterial chemoembolization (TACE). Materials and methods One hundred and fifteen patients, who required TACE for hepatocellular carcinoma (HCC) and suffered postembolization pain, were randomized into control group (n=63) and HE group (n=52). The health knowledge was scaled with the health knowledge questionnaire (HKQ). The postembolization pain was scored using a 0–10 numeric rating scale (NRS-10) after arterial embolization in both groups. Results There were no statistical differences between male and female in all HKQ scores (P>0.05). The HKQ scores of young people (≤45 years old) were significantly higher than those of elders (>45 years old; P<0.05). After teaching HE, the HKQ scores were significantly increased in patients of the HE group (P<0.01). The postembolization pain score in the HE group was significantly lower than that in the control group (P<0.05). The HKQ scores of question 1, 3, and total were negatively correlated with the pain score in this sample (P<0.05). Conclusion Improving the HE among HCC patients before TACE is beneficial for the pain relief during interventional procedure.
Collapse
Affiliation(s)
- Zi Xuan Wang
- Department of Interventional Radiology, Qingdao Municipal Hospital, Qingdao, Shandong, People's Republic of China
| | - Lin Li
- Department of Interventional Radiology, Qingdao Municipal Hospital, Qingdao, Shandong, People's Republic of China
| | - Feng Ying Tao
- Department of Oncology, Qingdao Municipal Hospital, Qingdao, Shandong, People's Republic of China,
| |
Collapse
|
|
16
|
Li G, Liang Y, Sun C, Peng X, Hao N, Liu M, Gao W, Wu H, He B. Effective combination therapy of percutaneous ethanol injection and chemotherapy based on injectable low molecular weight gels. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2018; 46:683-693. [PMID: 29741394 DOI: 10.1080/21691401.2018.1468766] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Percutaneous ethanol injection (PEI) therapy was used in liver cancer treatment, however, the therapeutic ethanol in PEI easily flew away from injected solid tumours and hinder the treatment effect. In this paper, injectable supramolecular gels formed by self-assembly of low molecular weight gelators (LMWGs) based on glycylglycine modified phenylboronic acid were prepared to localize ethanol and load chemotherapeutic drug for in situ synergistic therapy. The mechanism, morphology and rheological property of supramolecular gels were characterized by NMR, UV, SEM, etc. The rheological study revealed that the gels were formed in situ rapidly and recovered promptly once damaged. The gels were non-toxicity to both normal 3T3 fibroblasts cells and 4T1 breast cancer cells. Doxorubicin (DOX) hydrochloride and ethanol were encapsulated in the gels for the combination of chemotherapy and PEI therapy. The in vivo anticancer activity of the DOX-loaded gels was carried out in tumour bearing mice. The injected gels were coated around tumour tissues to lock ethanol, and DOX was released sustainingly from the gels to maintain effective concentration to induce the apoptosis of tumour cells. DOX-loaded gels and the ethanol exhibited excellent therapeutic efficacy and low side effects in local cancer therapy.
Collapse
Affiliation(s)
- Guotao Li
- a College of Chemistry and Materials Engineering , Wenzhou University , Wenzhou , China
| | - Yan Liang
- b Department of Pharmaceutics, School of Pharmacy , Qingdao University , Qingdao , China
| | - Changzhen Sun
- c National Engineering Research Center for Biomaterials , Sichuan University , Chengdu , China
| | - Xinyu Peng
- c National Engineering Research Center for Biomaterials , Sichuan University , Chengdu , China
| | - Na Hao
- c National Engineering Research Center for Biomaterials , Sichuan University , Chengdu , China
| | - Miaochang Liu
- a College of Chemistry and Materials Engineering , Wenzhou University , Wenzhou , China
| | - Wenxia Gao
- a College of Chemistry and Materials Engineering , Wenzhou University , Wenzhou , China
| | - Huayue Wu
- a College of Chemistry and Materials Engineering , Wenzhou University , Wenzhou , China
| | - Bin He
- c National Engineering Research Center for Biomaterials , Sichuan University , Chengdu , China
| |
Collapse
|
|
17
|
Efficacy of 125I Versus Non- 125I Combined with Transcatheter Arterial Chemoembolization for the Treatment of Unresectable Hepatocellular Carcinoma with Obstructive Jaundice. Dig Dis Sci 2018; 63:321-328. [PMID: 29305738 DOI: 10.1007/s10620-017-4899-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 12/21/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the therapeutic effects of 125I versus non-125I combined with transcatheter arterial chemoembolization (TACE) for the treatment of unresectable hepatocellular carcinoma (HCC) with obstructive jaundice. METHODS A retrospective analysis was conducted using the records of 54 consecutive patients who were initially diagnosed with HCC with obstructive jaundice between May 2009 and July 2016. Twenty-one cases (group A) were treated with percutaneous transhepatic biliary drainage (PTBD) followed by 125I radioactive seed strip implantation through the PTBD tube. After the total serum bilirubin level was reduced to normal and the liver function recovered to Child-Pugh class A or early B, TACE was conducted. In 33 cases (group B) PTBD was performed in combination with TACE without applying the 125I radioactive seeds. The duration of biliary patency and survival were analyzed. RESULTS The technical success rate in both groups was 100%. The median biliary patency time was 6.000 ± 0.315 months (95% CI 5.382-6.618 months) in group A and 4.000 ± 0.572 months (95% CI 2.879-5.121 months) in group B; the two groups were significantly different (P = 0.001). The median survival was 11.000 ± 0.864 months (95% CI 9.306-12.694 months) in group A and 9.000 ± 0.528 months (95% CI 7.965-10.035 months) in group B; the two groups were significantly different (P = 0.022). CONCLUSIONS The combination of 125I with TACE was more effective than TACE without the radioactive seeds for treating patients with unresectable HCC with obstructive jaundice. Future prospective trials with larger samples will be required to validate these results.
Collapse
|
|
18
|
Foog DHS, Kwok D, Yu BCY, Wong VWS. Managing HCC in NAFLD. CURRENT HEPATOLOGY REPORTS 2017; 16:374-381. [DOI: 10.1007/s11901-017-0376-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
|
|
19
|
Zhou L, Zhang LZ, Wang JY, Li YW, Hu HD, Peng XM, Zhao Y, Wang XM, Xie H, Liu CZ, Wang HM. Perioperative safety analysis of transcatheter arterial chemoembolization for hepatocellular carcinoma patients with preprocedural leukopenia or thrombocytopenia. Mol Clin Oncol 2017; 7:435-442. [PMID: 28811901 DOI: 10.3892/mco.2017.1345] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 07/22/2017] [Indexed: 01/05/2023] Open
Abstract
Patients with hepatocellular carcinoma (HCC) exhibit a high incidence of concomitant cirrhosis with leukopenia and/or thrombocytopenia. In the present study, perioperative changes in the white blood cell (WBC) and platelet (PLT) counts and associated complications were investigated to assess the safety of transcatheter arterial chemoembolization (TACE) for HCC patients with preprocedural leukopenia or thrombocytopenia. The records of 1,461 HCC patients who received TACE between January 2012 and December 2013 were retrospectively reviewed. The incidence of complications during the perioperative period and changes in the WBC and PLT counts were recorded. A Chi-squared test was used to evaluate the associations between postoperative infection and preprocedural WBC count and between bleeding at the puncture site and preprocedural PLT count. The WBC count of the majority of the patients increased within 3 days and returned to the preprocedural level within 30 days after TACE. The PLT count decreased within 3 days and returned to the preprocedural level within 30 days after TACE. The major complications were liver decompensation (n=66), puncture site bleeding (n=45), infection (n=33), severe thrombocytopenia (n=8), upper gastrointestinal bleeding (n=6), tumor bleeding (n=4) and agranulocytosis (n=3). A Chi-squared test revealed that postoperative infection was not associated with preprocedural WBC count and puncture site bleeding was not associated with decreased PLT count due to hypersplenism. Therefore, TACE was found to be safe for HCC patients with preprocedural thrombocytopenia or leukopenia due to hypersplenism, with a low incidence of major complications during the perioperative period.
Collapse
Affiliation(s)
- Lin Zhou
- Department of Interventional Radiology, Beijing 302 Hospital, Beijing 100039, P.R. China
| | - Lin-Zhi Zhang
- Department of Interventional Radiology, Beijing 302 Hospital, Beijing 100039, P.R. China
| | - Jing-Yan Wang
- Department of Interventional Radiology, Beijing 302 Hospital, Beijing 100039, P.R. China
| | - Yong-Wu Li
- Department of Radiology, Beijing 302 Hospital, Beijing 100039, P.R. China
| | - Hai-Dong Hu
- Department of Radiology, Beijing 302 Hospital, Beijing 100039, P.R. China
| | - Xiao-Ming Peng
- Department of Interventional Radiology, Beijing 302 Hospital, Beijing 100039, P.R. China
| | - Yun Zhao
- Department of Interventional Radiology, Beijing 302 Hospital, Beijing 100039, P.R. China
| | - Xi-Ming Wang
- Department of Interventional Radiology, Beijing 302 Hospital, Beijing 100039, P.R. China
| | - Hui Xie
- Department of Interventional Radiology, Beijing 302 Hospital, Beijing 100039, P.R. China
| | - Chun-Zi Liu
- Department of Interventional Radiology, Beijing 302 Hospital, Beijing 100039, P.R. China
| | - Hua-Ming Wang
- Department of Interventional Radiology, Beijing 302 Hospital, Beijing 100039, P.R. China
| |
Collapse
|
|
20
|
Kohi MP. Gender-Related Differences in Hepatocellular Carcinoma: Does Sex Matter? J Vasc Interv Radiol 2017; 27:1338-1341. [PMID: 27566425 DOI: 10.1016/j.jvir.2016.06.035] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 06/28/2016] [Accepted: 06/28/2016] [Indexed: 02/07/2023] Open
Affiliation(s)
- Maureen P Kohi
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave., M-361, San Francisco, CA 94143.
| |
Collapse
|
|
21
|
Yoo SH, Jang JW, Kwon JH, Jung SM, Jang B, Choi JY. Preemptive antiviral therapy with entecavir can reduce acute deterioration of hepatic function following transarterial chemoembolization. Clin Mol Hepatol 2016; 22:458-465. [PMID: 28081589 PMCID: PMC5266345 DOI: 10.3350/cmh.2016.0054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/05/2016] [Accepted: 10/13/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND/AIMS Hepatic damage during transarterial chemoembolization (TACE) is a critical complication in patients with hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). Apart from its role in preventing HBV reactivation, there is some evidence for the benefits of preemptive antiviral therapy in TACE. This study evaluated the effect of preemptive antiviral therapy on acute hepatic deterioration following TACE. METHODS This retrospective observational study included a prospectively collected cohort of 108 patients with HBV-related HCC who underwent TACE between January 2007 and January 2013. Acute hepatic deterioration following TACE was evaluated. Treatment-related hepatic decompensation was defined as newly developed encephalopathy, ascites, variceal bleeding, elevation of the bilirubin level, prolongation of prothrombin time, or elevation of the Child-Pugh score by ≥2 within 2 weeks following TACE. Univariate and multivariate analyses were conducted to identify factors influencing treatment-related decompensation. Preemptive antiviral therapy involves directing prophylaxis only toward high-risk chronic hepatitis B patients in an attempt to prevent the progression of liver disease. We regarded at least 6 months as a significant duration of preemptive antiviral treatment before diagnosis of HCC. RESULTS Of the 108 patients, 30 (27.8%) patients received preemptive antiviral therapy. Treatment-related decompensation was observed in 25 (23.1%) patients during the follow-up period. Treatment-related decompensation following TACE was observed more frequently in the nonpreemptive group than in the preemptive group (29.5% vs. 6.7%, P=0.008). In the multivariate analysis, higher serum total bilirubin (Hazard ratio [HR] =3.425, P=0.013), hypoalbuminemia (HR=3.990, P=0.015), and absence of antiviral therapy (HR=7.597, P=0.006) were significantly associated with treatment-related hepatic decompensation. CONCLUSION Our findings suggest that preemptive antiviral therapy significantly reduces the risk of acute hepatic deterioration. Preventing hepatic deterioration during TACE by applying such a preemptive approach may facilitate the continuation of anticancer therapy and thus improve long-term outcomes.
Collapse
Affiliation(s)
- Sun Hong Yoo
- Department of Internal Medicine, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Jeong Won Jang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hyun Kwon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Min Jung
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bohyun Jang
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jong Young Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
|
22
|
Chinese herbal formula for postprandial distress syndrome: Study protocol of a double-blinded, randomized, placebo-controlled trial. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2016.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|