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Textbook Outcome After Trans-arterial Chemoembolization for Hepatocellular Carcinoma

  • Scientific Paper (Other)
  • Interventional Oncology
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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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Abbreviations

TO:

Textbook outcome

TACE:

Trans-arterial chemoembolization

HCC:

Hepatocellular carcinoma

OR:

Objective response

ECOG:

Eastern cooperative oncology group

TAE:

Trans-arterial bland embolization

CBCT:

Cone-beam computed tomography

PES:

Post-embolization syndrome

AE:

Adverse events

CTCAE:

Common terminology criteria for adverse events

HCV:

Hepatitis C virus

DEB:

Drug-eluting beads

ECOG:

Eastern cooperative oncology group

PS:

Performance status

MELD:

Model for end-stage liver disease

ALBI:

Albumin-bilirubin

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Funding

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Author information

Authors and Affiliations

Authors

Contributions

CM had the original idea; AC planned and coordinated the multicenter data collection; JO, RK, LS, RG, CC, WF, BO, EG, MP-R, AB, YTM, FS, DB, PG, GA, YL, CS and EG collected clinical data and/or performed the procedures; AC performed the analyses, CM and AC wrote the manuscript. PJ provided critical review for important intellectual contents.

Corresponding author

Correspondence to Cristina Mosconi.

Ethics declarations

Conflict of interest

None declared.

Consent for Publication

Consent for publication was obtained for every individual person’s data included in the study.

Ethical Approval

The present retrospective study was approved by the institutional review board (local IRB no. 193/2021/Oss/AOUBo).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

A. Cucchetti has full responsibility for the conduct of the study.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 121 KB)

Appendix

Appendix

Adverse events definitions

AE Grading

Grades 1–2

Grades 3–4

Post-Embolization Syndrome (PES)

Mild pain, with or without fever, with or without nausea / vomiting requiring eventual administration of analgesic, antiemetics, antipyretics

Moderate to severe pain, with mild to moderate peritonitis requiring narcotics, fever requiring antibiotics, vomiting requiring naso-gastric tube placement

Cholecystitis (Acute)

Asymptomatic with radiographic findings only/Symptomatic requiring medical intervention

Interventional radiology, endoscopic, or operative intervention indicated / Life-threatening consequences (i.e., sepsis or perforation)

Pancreatitis (Acute)

Asymptomatic, enzyme elevation and/or radiographic findings or symptomatic, medical intervention indicated

Interventional radiology or operative intervention indicated / Life-threatening consequences (i.e., circulatory failure, hemorrhage, sepsis)

Liver Abscess

Radiological finding only without any clinical signs of systemic infection. Analgesics and electrolytes allowed

Antibiotic, antifungal intervention indicated; radiologic or surgical intervention indicated / Life-threatening consequences

Acute kidney injury

Creatinine 2–3 × above baseline value

Creatinine > 3 × baseline or > 4.0 mg/dL or requiring dialysis

Inguinal hematoma

Mild symptoms / minimally invasive evacuation or aspiration indicated, medical therapy

Transfusion, radiologic, endoscopic or intervention indicated

Liver dysfunction

Transient bilirubin increases ≥ 50% compared with baseline, Albumin decrease by 0.3 g/dL, AST or ALT increase of > 25%, INR increase of ≥ 25%, eventual albumin supplementation for ascites

Development of jaundice, encephalopathy, increasing ascites eventually requiring drainage/Life-threatening consequences

GI bleeding

Hematemesis or tarry stool without the need for transfusion or endoscopy

Transfusion, radiologic, endoscopic or intervention indicated/Life-threatening consequences

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Mosconi, C., O’Rourke, J., Kloeckner, R. et al. Textbook Outcome After Trans-arterial Chemoembolization for Hepatocellular Carcinoma. Cardiovasc Intervent Radiol 46, 449–459 (2023). https://doi.org/10.1007/s00270-023-03375-4

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