Patients Undergoing Transcatheter Arterial Chemoembolization Research Articles

Symptom clusters and nutritional status in primary liver cancer patients receiving transcatheter arterial chemoembolization.

Introduction: symptom clusters (SCs) are highly prevalent among patients diagnosed with primary liver cancer. Malnutrition poses a heightened risk for a more pronounced total symptom cluster score. Objective: this study aimed to identify SCs and assess the nutritional status of patients undergoing transcatheter arterial chemoembolization (TACE). Furthermore, it aimed to investigate the association between nutritional status and symptom clusters. Methods: primary liver cancer patients who were scheduled to receive TACE were recruited. Symptoms data were collected using the MD Anderson Symptom Inventory (MDASI-C) and the Symptom Module specific to Primary Cancer (TSM-PLC). Nutritional assessment relied on the Nutritional Risk Screening-2002 (NRS-2002) and blood biochemistry. The SCs were extracted using exploratory factor analysis, while the relationship between SCs and nutritional status was evaluated using Spearman correlation analysis. Results: the study included 226 patients, four distinct symptom clusters emerged: emotional-psychological symptom cluster, upper gastrointestinal symptom cluster, post-embolization-related symptom cluster, and liver function impairment symptom cluster. 68.14 % of patients were found to be at high risk of malnutrition. Our study revealed significant differences in Scs scores between patients at risk of malnutrition and those without such risk (p < 0.050). Notably, we observed a positive correlation between NRS-2002 scores and the scores of all symptom clusters (r = 0.205 to 0.419, p < 0.001), while a negative correlation was observed between prealbumin levels and the scores of all symptom clusters (r = -0.183 to -0.454, p < 0.001). Conclusion: the study highlights the high risk of malnutrition among liver cancer patients receiving TACE and the positive correlation between high malnutrition risk and Scs scores.

Acute changes of superior mesenteric artery pressure after intraarterial bolus injection of prostaglandin-E1.

Background: A bolus injection of prostaglandin-E1 (PGE1) into the superior mesenteric artery (SMA) immediately before SMA-portography can effectively visualize the portal vein. Objective: The purpose of this study was to obtain basic pharmacoangiographical data and evaluate the hemodynamic changes following intra-arterial bolus injection of PGE1. Materials and Methods: Forty-four consecutive patients undergoing transcatheter arterial chemoembolization (TACE) for liver cancer were retrospectively evaluated. SMA-portography was performed prior to TACE. An intra-arterial bolus injection of PGE1 was performed immediately before SMA-portography. Both SMA pressure and left brachial artery pressure were measured before, 1, 2, 3, 4, and 5 minutes after SMA-portography. Results: Systolic pressure in the SMA decreased significantly 3 minutes after SMA-portography and remained low for 5 minutes. The maximum reduction rates in systolic and diastolic blood pressure in the SMA were 4.8% (4 minutes after SMA-portography) and 6.8% (5 minutes after SMA-portography), respectively. The left brachial artery pressure decreased similarly to the SMA. There were no significant changes in pulse pressure before or after PGE1 injection in either the SMA or brachial arteries. Conclusion: A bolus injection of PGE1 into the SMA was shown to decrease blood pressure in the SMA and brachial arteries, but the pulse pressure remained constant.

Efficacy and Safety of Distal Radial Access for Transcatheter Arterial Chemoembolization (TACE) of the Liver.

The distal radial artery has emerged as an alternative vascular-access site to conventional transfemoral and transradial approaches. The main advantage over the conventional transradial route is the reduced risk of radial artery occlusion, especially in those patients who, for various clinical reasons, have to undergo repeated endovascular procedures. This study aims to assess the efficacy and safety of distal radial access for transcatheter arterial chemoembolization of the liver. This investigation is a single-center retrospective analysis of 42 consecutive patients who had undergone, from January 2018 to December 2022, transcatheter arterial chemoembolization of the liver with distal radial access for intermediate-stage hepatocellular carcinoma. Outcome data were compared with a retrospectively constituted control group of 40 patients undergoing drug-eluting beads-transcatheter arterial chemoembolization with femoral access. Technical success was achieved in all cases, with a 2.4% conversion rate for distal radial access. A superselective chemoembolization was performed in 35 (83.3%) cases of distal radial access. No episode of radial artery spasm or radial artery occlusion occurred. No significant differences in efficacy and safety were observed between the distal radial access group and the femoral access group. Distal radial access is effective, safe, and comparable to femoral access in patients undergoing transcatheter arterial chemoembolization of the liver.

Effect of HBsAg expression in liver tissue on prognosis of hepatocellular carcinoma after minimally invasive interventional therapy.

The aim of this study was to investigate the association between pathologic markers and prognosis in patients with hepatocellular carcinoma who received transcatheter chemoembolization combined with locoregional ablation therapy. This retrospective study included 111 hepatitis B virus (HBV)-associated hepatocellular carcinoma (HCC). All patients underwent transcatheter arterial chemoembolization (TACE) combined with locoregional ablation therapy, and received core needle biopsy before therapy in Beijing You 'an Hospital affiliated to Capital Medical University from January 1, 2013 to December 31, 2016. Demographic, pathological indicators and clinical laboratory data were collected. The cumulative recurrence-free survival (RFS) and overall survival (OS) were calculated and compared by Kaplan-Meier method and Log-rank test, and Cox proportional risk model was used to screen for independent predictors of recurrence and long-term prognosis in HCC patients. There was a correlation between HBsAg expression in liver tissue and prognosis of HCC patients. Patients with negative HBsAg expression had longer 1-,3- and 5-year RFS rates than positive HBsAg expression (78.3%, 43.5%, 30.4% and 58.5%, 24.5%, 17.0%, P=0.018). Meanwhile,the postoperative 1-,3-and 5-year OS rates of HCC patients in the negative HBsAg expression group were significantly higher than those of HCC patients in the positive HBsAg expression group (100%, 89.1%, 80.4% and 100%, 75.5%, 58.5%, P=0.008). The prognosis of patients with hepatocellular carcinoma with negative HBsAg expression was better than that with positive HBsAg expression. Accordingly, the expression of the liver HBsAg before combined therapy was a prognostic indicator for OS and RFS. For patients with liver HBsAg positive, follow-up should be strengthened and corresponding intervention measures should be taken to improve prognosis.

Serum T Cell Immunoglobulin Mucin 3 Predicts Worse Prognosis in Hepatocellular Carcinoma Patients Undergoing Transcatheter Arterial Chemoembolization.

BackgroundHepatocellular carcinoma (HCC) is currently a leading cause of cancer-related death, and its prognostic evaluation remains a challenge. We aimed to explore the predictive value of T cell immunoglobulin and mucin 3 (Tim-3) in HCC patients undergoing transcatheter arterial chemoembolization (TACE).Material/MethodsFor the present study, 167 HCC patients who had undergone TACE were retrospectively recruited and randomly stratified into 2 subgroups at a ratio of about 2: 1 (training: 109; validation: 58) using EXCEL software. Pre-TACE serum was collected from all of these patients, and in a second visit a month after the initial treatment, an additional serum sample was collected from 45 patients in the training set. Tim-3 concentrations were determined by enzyme-linked immunosorbent assay. Kaplan-Meier survival curves analysis, log-rank tests, and Cox proportional hazard regression model were applied to evaluate prognostic significance.ResultsPatients whose cancer progressed after TACE had significantly higher serum Tim-3 in both the training and validation sets (both P<0.05). Kaplan-Meier analysis revealed that patients with elevated serum Tim-3 had significantly shorter time-to-progression and overall survival in both the training and validation sets (both P<0.05). Multivariate Cox regression analysis confirmed that elevated pre-TACE Tim-3 served as a novel, independent indicator for predicting poor prognosis in HCC [progression, hazard ratio (HR) 2.197; 95% confidential interval (CI) 1.408–3.373; P<0.001; death, HR 2.570; 95% CI 1.508–4.378; P=0.001], which was further verified in the validation set (progression P=0.005; death P=0.043). Interestingly, serum Tim-3 retained its prognostic significance in the α-fetoprotein-negative subgroup. Notably, patients with high Tim-3 levels after TACE encountered dismal outcomes.ConclusionsSerum Tim-3 might be a satisfactory prognostic indicator for HCC patients undergoing TACE.

Elevated soluble programmed death-ligand 1 levels indicate immunosuppression and poor prognosis in hepatocellular carcinoma patients undergoing transcatheter arterial chemoembolization

AIMSThe present study aimed to determine the prognostic significance of soluble Programmed Death-ligand 1 (sPD-L1) in hepatocellular carcinoma (HCC) patients undergoing transcatheter arterial chemoembolization (TACE). METHODSWe treated 114 HCC patients with TACE from 2012 to 2013 and determined their sPD-L1 levels by enzyme-linked immunosorbent assay. We evaluated prognosis according to mRESIST criteria and analyzed prognostic values by Cox regression and Kaplan-Meier analysis. We further evaluated correlations between sPD-L1 level and inflammatory status, as well as immunosuppressive environment. RESULTSsPD-L1 levels were significantly increased in patients who developed HCC progression (P = 0.002) and death (P < 0.001). Patients with higher pre-treatment sPD-L1 levels had a significantly shorter time to progression (10.50 vs. 18.25 months, P = 0.001) and decreased overall survival (16.50 vs. 28.50 months, P = 0.003). Importantly, sPD-L1 levels positively correlated with SII (r = 0.284, P = 0.002), sIL-2R (r = 0.239, P = 0.010), IL-10 (r = 0.283, P = 0.002), HBV-DNA loads (r = 0.229, P = 0.014), and CRP (r = 0.237, P = 0.011). Moreover, high sPD-L1 levels had increased numbers of Treg cells (FOXP3+; P = 0.026), Macrophage cells (CD68+; P = 0.014), and M2-Macrophage cells (CD163+; P = 0.026) CONCLUSIONSsPD-L1 level is a prognostic indicator of poor outcomes after TACE. High sPD-L1 might reflect increased immune activation in an immunosuppressive environment that hindered anti-tumor response activity.

Prediction of short-term prognosis of hepatocellular carcinoma after TACE surgery based on MRI texture analysis technology

Objective: To explore the feasibility of short-term efficacy prognosis prediction model for HCC patients undergoing transcatheter arterial chemoembolization (TACE) based on MRI-based radiomics technique. Methods: A total of 123 patients with liver cancer who received TACE treatment in Lishui Central Hospital from June 2016 to July 2018 were retrospectively collected, including 90 males and 33 females, with an average age of 24-83 (58±10) years. All the patients were pathologically confirmed as hepatocellular carcinoma and underwent MRI scan before surgery.All patients were followed up 3-4 months after TACE, and further divided into training group (n=85, 42 of which were effective and 43 cases were ineffective) and the validation group (n=38, 19 of which were effective and 19 were ineffective) according to the modified response evaluation criteria in solid tumors (mRECIST). There was no statistical difference in the general information between the two groups of patients, which was comparable. Then, preoperative T(2)WI images were used for radiomics analysis, texture parameters were screened based on R language, and short-term efficacy prediction model of TACE for training group and verification group was constructed. Results: T(2)WI image analysis of each patient received 396 different texture parameters, and further used Lasso dimensionality reduction and 10 times cross-validation screening to obtain 5 characteristic texture parameters, specifically stdDeviation, ClusterProminence_angle135_offset4, Correlation_angle135_offset4, Inertia_angle135_offset4, InverseDifferenceMoment_angle45_offset4. According to the above five texture parameters and their corresponding coefficient values, the corresponding radiomics scores (Radscore) were calculated, and the prediction models of the training group and the verification group were further constructed.It was found that the area under the ROC curve of the training group was 0.812 (95%CI: 0.722-0.901), the sensitivity and specificity were 83.7% and 69.0%, respectively. The area under the ROC curve of the validation group was 0.801 (95%CI:0.654-0.947), and the sensitivity and specificity were 89.5% and 63.2%, respectively. Conclusion: The constructed TACE prediction model in the present study has high prediction accuracy, sensitivity and specificity.The short-term efficacy prognosis prediction model for HCC based on MRI is constructed, stable and reliable.

738P - Soluble programmed death-ligand 1 indicate poor prognosis in hepatocellular carcinoma patients undergoing transcatheter arterial chemoembolization

BackgroundSoluble programmed death-ligand 1 (sPD-L1) is associated with hepatocellular carcinoma (HCC) prognosis after resection or radiotherapy. However, its value in patients who received transcatheter arterial chemoembolization (TACE) remains unclear. The present study aimed to determine the prognostic significance of sPD-L1 in TACE subgroup. Methods114 HCC patients with hepatitis B virus (HBV)-background who received TACE from 2012 to 2013 were recruited. sPD-L1 levels were determined by enzyme-linked immunosorbent assay. We evaluated prognoses according to mRESIST criteria and analyzed prognostic values by Cox regression and Kaplan-Meier analysis. We further evaluated correlations between sPD-L1 and systemic inflammation index (SII), soluble interleukin-2 receptor (sIL-2R), IL-10, hepatitis B virus (HBV)-DNA loads, and C-reactive protein. ResultsSignificantly elevated sPD-L1 levels were found in patients who developed HCC progression (P=0.002) and death (P<0.001). Patients with higher pre-treatment sPD-L1 levels had a significantly shorter time to progression (10.50 vs. 18.25 months, P=0.001) and decreased overall survival (16.50 vs. 28.50 months, P=0.003). In low-recurrence-risk subgroups, sPD-L1 levels retained prognostic value (P<0.050). Importantly, multivariate regression confirmed that pre-treatment sPD-L1 level was an independent predictor for both progression [hazard ratio (HR) 1.82; P=0.032] and survival (HR 1.84; P=0.009). Moreover, sPD-L1 levels positively correlated with SII (r=0.284, P=0.002), sIL-2R (r=0.239, P=0.010), IL-10 (r=0.283, P=0.002), HBV-DNA loads (r=0.229, P=0.014), and CRP (r=0.237, P=0.011). ConclusionssPD-L1 level is a prognostic indicator of poor outcomes after TACE. High sPD-L1 indicated increased immune activation in an immunosuppressive environment that hindered anti-tumor response activity. Lowering sPD-L1 levels may provide a novel avenue for preventing HCC progression post-TACE. Legal entity responsible for the studyThe authors. FundingThe National Natural Science Foundation of China (87172263 and 81572064) and Key Developing Disciplines of Shanghai Municipal Commission of Health and Family Planning (2015ZB0201). DisclosureAll authors have declared no conflicts of interest.

Prognostic significance of lymphocyte-to-monocyte ratio and platelet-to-lymphocyte ratio in patients with hepatocellular carcinoma undergoing transcatheter arterial chemoembolization and radiofrequency ablation.

BackgroundHepatocellular carcinoma (HCC) ranks fifth among malignancies globally. Previous studies have shown that systemic inflammatory response, platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) are associated with poor prognosis of various types of cancer.Materials and methodsRadiofrequency ablation (RFA) was performed using an internal cooling electrode with a 2- or 3-cm exposed tip. The LMR was calculated as the ratio of lymphocytes to monocytes. In order to explore the influence of pretreatment with PLR and LMR on survival of HCC patients undergoing transcatheter arterial chemoembolization (TACE) and RFA, 204 cases with HCC which accepted RFA and TACE were retrospectively analyzed and assigned into 2 groups based on optimal cutoff values for LMR (low: ≤2.13 or high: >2.13) and PLR (low: ≤95.65 or high: >95.65).ResultsPatients with a lower PLR had a longer overall survival (OS) compared to those with a higher PLR (median OS, 20 versus 13 months), and patients with a higher LMR had a longer OS than those with a lower LMR (OS, 22 versus 10 months). Multivariate logistic regression analysis was performed using Cox proportional hazards regression analysis for multiple prognostic factors and identified PLR and LMR as prognostic factors for OS of HCC cases.ConclusionWe conclude that PLR and LMR, whose detection is generally available and affordable, may be novel noninvasive circulating markers to potentially assist doctors assess the prognosis of patients.

Efficacy of surgical microwave ablation for recurrent hepatocellular carcinoma after curative hepatectomy

BackgroundLittle evidence exists regarding postrecurrence survival after microwave ablation for recurrent hepatocellular carcinoma (HCC) after curative hepatectomy; we aimed to evaluate the feasibility of surgical microwave ablation. MethodsIn this retrospective review, we enrolled patients who underwent curative hepatectomy for primary HCC in our department and had intrahepatic recurrence. We analyzed overall survival according to treatment modality to clarify the prognostic factors for survival. ResultsOf 257 patients, 119 had intrahepatic recurrence. Three patients underwent repeat hepatectomy; 75 patients underwent surgical microwave ablation, and 34 patients underwent transcatheter arterial chemoembolization or hepatic arterial infusion chemotherapy. The median postrecurrence survival time and 5-year postrecurrence survival after surgical microwave ablation were 37.4 months and 55.4%, respectively. The major complication rate (Clavien–Dindo classification IIIa or above) after surgical microwave ablation was 5.3% with no mortality. Multivariate analysis showed that microvascular invasion at primary tumors, and recurrent tumors within 3 cm and 3 nodules were independent prognostic factors for overall survival after surgical microwave ablation for recurrent HCC. ConclusionOur results suggested that surgical microwave ablation is safe and feasible for recurrent intrahepatic HCC after curative hepatectomy. Close follow-up and further curative treatment could be important for improving postrecurrence survival.

The pretreatment platelet count is an independent predictor of tumor progression in patients undergoing transcatheter arterial chemoembolization with hepatitis B virus-related hepatocellular carcinoma.

To explore the prognostic value of the pretreatment platelet (PLT) count in patients undergoing transcatheter arterial chemoembolization (TACE) with hepatocellular carcinoma (HCC). We prospectively analyzed 317 hepatitis B virus-related HCC patients undergoing TACE. Time to progression (TTP) was selected to evaluate the clinical significance of PLT level in HCC patients. PLT was the only parameter showing statistical significance of all the clinical characteristics between two distinct tumor response groups. After ruling out cirrhosis as a potential major confounding factor, the conclusion was further established. Higher pretreatment PLT level, portal vessel invasion and higher stratification of α-fetoprotein level were independently associated with longer TTP. The prognostic score model combining the three risk factors revealed that higher risk scores might mean shorter TTP. The pretreatment PLT level is a potentially useful biomarker to predict the prognostic outcomes in HCC patients undergoing TACE and deserves to be further explored in subsequent works.

Retrospective Analysis of Chinese Patients with Hepatocellular Carcinoma (HCC) undergoing Transcatheter Arterial Chemoembolization (TACE) with or without Prophylactic Antibiotic Therapy.

To assess the necessity of prophylactic antibiotic therapy in HCC patients undergoing transcatheter arterial chemoembolization (TACE). Descriptive study. The First Affliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China, from August 2016 to August 2017. Retrospective TACE-treated cases were analysed in this study. The basic characteristics of the patients,the days in hospital, the laboratory data and fever after the procedure were assessed and compared. A review of literature of published studies and our present study were further conducted to determine the necessity of prophylactic antibiotic therapy. In 159 cases, there were no significant difference in the leukocyte count (p=0.552), neutrophil count (p=0.573) and fever (p=0.31) with and without prophylactic antibiotic therapy groups. The hospital stay was significantly increased in the prophylactic antibiotic group (p<0.001). The fever of previous and the present results showed no significant difference (p=0.25) between the groups. Prophylactic antibiotic therapy is not routinely necessary in the procedure of TACE for HCC patients.

Outcomes and Prognostic Factors of Spontaneously Ruptured Hepatocellular Carcinoma

BackgroundSpontaneous tumor rupture is a rare and life-threatening complication of hepatocellular carcinoma (HCC). The best treatment strategy remains unclear. MethodsThe clinical data of 137 patients with spontaneously ruptured HCC from 2010 to 2015 were reviewed retrospectively. We investigated the outcome and prognostic factors of various treatment strategies. ResultsOf the 137 patients, 53, 45, 3, and 36 patients underwent transcatheter arterial chemoembolization (TACE) alone, liver resection (LR) (LR alone or TACE + LR), surgical hemostasis, and conservative therapy. The patients undergoing LR had longest overall survival (OS). In the TACE alone group, independent factors affecting 30-day mortality were MELD score ≥ 12, AFP ≥ 1000 ng/ml, and largest tumor size ≥ 10 cm. AFP ≥ 1000 ng/ml, largest tumor size ≥ 10 cm, and no tumor capsule were significantly associated with poorer OS. In the LR group, largest tumor size ≥ 10 cm and no tumor capsule were the only independent prognostic factors for poorer OS and recurrence-free survival (RFS). Hypovolemic shock was an independent prognostic factor for poorer OS. The differences in OS between the TACE + LR group and LR alone group were not significant (P = 0.955). However, the RFS is significantly better in the LR alone group than those in the TACE + LR group (P = 0.031). ConclusionFor resectable tumor, LR is the treatment of choice for patients with spontaneous ruptured HCC and preserved liver function. The delay in LR due to preoperative TACE may account for its worse RFS compared with LR alone. In patients with an unresectable tumor, TACE therapy alone improved survival over conservative therapy.

Outcomes and prognostic factors of spontaneous ruptured hepatocellular carcinoma

Introduction: Spontaneous tumor rupture is a rare and life-threatening complication of HCC.This study aimed to investigate the outcomes of different management strategies and prognostic factors of patients with ruptured HCC. Methods: The clinical data of 137 patients with spontaneously ruptured HCC from January 2010 to December 2015 were analyzed retrospectively. Results: Of the 137 patients, 53, 45, 3, and 36 patients underwent transcatheter arterial chemoembolization (TACE) alone, liver resection (LR) (LR alone or TACE+LR combined), surgical hemostasis, or conservative therapy. The patients undergoing LR had longest overall survival (OS). In the LR group, largest tumor size≥10cm and no tumor capsule were the only independent prognostic factors for poorer OS and recurrence-free survival (RFS). Hypovolemic shock was an independent prognostic factor for poorer OS. The median time between diagnosis and LR was significantly longer in the TACE+LR group than in LR alone group (P< 0.01). The differences in OS between the TACE+LR group and LR alone group were not significant (P=0.955). However, the RFS is significantly better in the LR alone group than those in the TACE+LR group(P=0.031). In the TACE alone group, AFP≥1000 ng/ml, largest tumor size≥10cm, no tumor capsule and unsuccessful embolization were significantly associated with poorer OS. Conclusion: For resectable tumor, LR is the treatment of choice for patients with spontaneous ruptured HCC and preserved liver function. The delay in LR due to preoperative TACE may account for its worse RFS compared with LR alone. In patients with an unresectable tumor, TACE therapy alone improved survival over conservative therapy.

Effects of patient-controlled intravenous analgesia using hydromorphone supplement with dexmedetomidine on patients undergoing transcatheter arterial chemoembolization

Objective: To evaluate the safety and efficiency of patient-controlled intravenous analgesia (PCIA) using hydromorphone supplement with dexmedetomidine on patients undergoing transcatheter arterial chemoembolization. Methods: One hundred and eighty patients, age ranged from 40 to 65 years, body mass index from 18 to 25 kg/m(2,) ASA physical status Ⅱ-Ⅲ, who were scheduled for transcatheter arterial chemoembolization (TACE) under monitor anesthesia care (MAC) were randomly divided into 3 groups: hydromorphone group (H group), hydromorphone supplement with dexmedetomidine 1 μg/kg group (D1 group), hydromorphone supplement with dexmedetomidine 2 μg/kg group (D2 group), 60 patients in every group. All the groups of patients received PCIA pump, in the H group, the PCIA reagent was composed of 120 μg/kg hydromorphone and 5 mg tropisetron in 100 ml of normal saline. In comparison, PCIA regiment was composed of 120 μg/kg hydromorphone, 1 μg/kg dexmedetomidine and 5 mg tropisetron in 100 ml of normal saline in the D1 group, while 120 μg/kg hydromorphone, 2 μg/kg dexmedetomidine and 5 mg tropisetron in 100 ml of normal saline in the D2 group. The visual analogue scale (VAS) score, the observer's assessment of alertness/sedation scale (OAA/S) score, patients' satisfaction index, consumption of hydromorphone, the additional dose of morphine, the effective pressing times of PCIA and adverse reactions were recorded in detail at 0, 0.5, 1, 4, 12 and 24 hours after the patients underwent TACE. Results: The total consumptions of hydromorphone were (4.3±0.1), (4.1±0.1), and (3.8±0.1) mg in group H, D1, and D2, respectively, and the effective pressing times were 13±3, 6±2 and 2±1, the additional doses of morphine were (30±5), (15±3), and (3±1) mg, and adverse reaction rates were 45.0%, 28.3%, and 10.0%, respectively. The manifestations mentioned above in D2 group were significantly lower than those in group H and group D1 (P<0.05). Immediately and 5 min after embolization, at the end of surgery and 0.5, 1, 4, 12 and 24 h after surgery, the VAS scores in the D2 group were 1.9±0.2, 2.1±0.3, 1.8±0.4, 1.8±0.3, 1.7±0.3, 1.6±0.3, 1.3±0.2, 1.3±0.3, respectively, lower than those in group H and group D1 (P<0.05); The satisfaction index in D2 group at these times were 8.7±1.1, 8.9±0.8, 9.2±0.9, 9.0±0.7, 9.1±0.8, 9.0±0.6, 9.1±0.7, 9.2±0.9, respectively, higher than those in group H and group D1 (P<0.05). No breath depression happened in these three groups. Conclusion: The formula of hydromorphone combined with dexmedetomidine to patients undergoing TACE is greatly safe and efficient, with advantages in alleviating pain, reducing hydromorphone consumption and the incidence of adverse reaction of hydromorphone, and without breath depression.

Profiles Associated with Sarcopenia in Hepatoma Patients Underwent Transcatheter Arterial Chemoembolization: A Data‐Mining Analysis

AbstractAimsSarcopenia is a prognostic factor in patients with hepatocellular carcinoma (HCC). Transcatheter arterial chemoembolization (TACE) may aggravate sarcopenia because of post‐embolization syndrome. The aims of this study are to investigate changes in skeletal muscle mass after TACE and its risk profiles in patients with HCC.Methods and resultsWe enrolled 104 HCC patients (age 73.5 [41.0–88.0] years, female/male 35/69, body mass index 22.4 [16.0–32.7]). Changes in skeletal muscle mass were evaluated by Δskeletal muscle index (SMI) using computed tomography before and after TACE. Factors correlated with ΔSMI were evaluated. Independent factors and profiles associated with a decrease in SMI were evaluated by multivariate analysis and decision‐tree analysis, respectively. SMI was significantly decreased after TACE in patients with HCC (32.8 vs. 30.6 cm2/m2; P=0.0001). However, there was no significant correlation between the ΔSMI and other variables including Δalbumin. In the logistic regression analysis, no factor was significantly associated with a decrease in SMI. In the decision‐tree analysis, sex was selected as the initial split and, in female, 74% of subjects showed a decrease in SMI. While, in male, an estimated glomerular filtration rate (eGFR) ≤81.7 ml/min/1.73 m2 was the second split; of these patients, 74% of subjects had a decreased SMI.ConclusionsWe demonstrated that skeletal muscle mass was decreased after TACE in patients with HCC. “female” and “male who had a lower eGFR” were profile for a decrease in skeletal muscle mass. Thus, such patients who have HCC treated with TACE may benefit from preventive treatment for sarcopenia.

Epidemiology and Management of Acute Kidney Injury in Hepatocellular Carcinoma Patients Undergoing Transcatheter Arterial Chemoembolization.

Transcatheter arterial chemoembolization (TACE) is an effective therapy for hepatocellular carcinoma (HCC). However, acute kidney injury (AKI) may occur after TACE due to the contrast agent and cytotoxic anticancer drugs used in this procedure. Post-TACE AKI is not an unusual event, and may adversely affect patient outcome. Coexisting situations including cirrhosis, renal insufficiency, diabetes and hypertension play a role in the development of HCC, and may predispose patients to AKI after TACE. Most post-TACE are transient and reversible, while prolonged AKI may predict a decreased survival. The best strategy to manage post-TACE AKI is prevention. Patients, before undergoing TACE, should be carefully assessed. In this study, we reviewed the current literature published in English about the incidence rate, risk factors, management and prognosis of AKI in patients with HCC undergoing TACE for a better understanding of this complication.

Effects of self-management intervention on pain and quality of life in liver cancer patients underwent TACE

Objective To explore the effects of self-management intervention on pain and quality of life in liver cancer patients underwent transcatheter arterial chemoembolization (TACE). Methods Totally 97 liver cancer patients underwent TACE in our hospital from March 2013 to March 2016 were selected by convenience sample method and were divided into the observation group (n=49) and the control group (n=48). Patients of two groups were given self-management intervention and routine nursing intervention respectively. Strategies used by people to promote health (SUPPH), NRS-10 and functional assessment of cancer therapy-general (FACT-G) were used to evaluate the self-management, pain and life quality of patients before intervention, 7 d after intervention, 1 and 3 months after intervention were compared between two groups. Results Self-management in two groups before intervention had no significant difference (P>0.05), however, after intervention, self-management in the observation group was obviously increased, and was significantly higher than that of the control group (P 0.05). As for the pain degree, there was no difference in two groups before and after intervention (P>0.05), and after intervention, the pain degree were reduced in two groups, in addition, the data in the observation group was lower than that in the control group (P 0.05), but after intervention, the improvement of life quality in the observation group was higher than that in the control group (P<0.05). Conclusions Self-management intervention can improve self-management, reduce pain and improve life quality of liver cancer patients underwent TACE, so it is worthy of clinical application. Key words: Liver cancer; Self-management intervention; Pain; Quality of life; Transcatheter arterial chemoembolization

Hepatic resection versus transcatheter arterial chemoembolization for the treatment of hepatocellular carcinoma with hepatic vein tumor thrombus

To compare the outcomes of hepatic resection and transcatheter arterial chemoembolization for resectable hepatocellular carcinoma with hepatic vein tumor thrombus. From January 2006 to November 2013, 28 patients initially diagnosed with resectable hepatocellular carcinoma combined with hepatic vein tumor thrombus received hepatic resection. These patients were compared with 56 case-matched controls (1:2 ratio) selected from a pool of 91 patients who received transcatheter arterial chemoembolization as an initial treatment during the same period. Clinical characteristics, adverse events, overall survival and survival-related factors were analyzed. The 1-, 2- and 3-year overall survival rates were 66.5, 37.4 and 28.5% for the hepatic resection group and 32.3, 18.7 and 15.6% for the transcatheter arterial chemoembolization group (P = 0.015), respectively. No significant difference was found between the two groups in terms of complications and mortality. Multivariate analyses revealed combined portal vein tumor thrombosis (HR = 2.116; 95% CI: 1.26-3.57; P = 0.005) and treatment allocation (hepatic resection = 2.289; 95% CI, 1.30-4.02; P = 0.004) as risk factors for overall survival. Hepatic resection provides a good prognosis for hepatocellular carcinoma patients with hepatic vein tumor thrombus compared with patients undergoing transcatheter arterial chemoembolization, and the most important factor related to survival was co-existence with portal vein invasion.

Predictive value of serum insulin-like growth factor-1 in hepatocellular carcinoma.

Hepatocellular carcinoma (HCC) is the commonest primary malignant cancer of the liver in the world. Insulin-like growth factor-1 (IGF-1) levels reflect hepatic function and are inversely correlated with the severity of background chronic liver disease. This study evaluated whether basal serum IGF-1 levels can predict prognosis of HCC patients according to different risks of disease progression. A total of 89 patients with hepatocellular carcinoma (HCC) were recruited in 3 groups: Group I, 30 HCC patients receiving sorafinib; Group II, 30 HCC patients with best supportive care; and Group III include 29 patients undergoing transcatheter arterial chemoembolization (TACE). All patients were investigated for serum levels of AST, ALP, Bb, Cr, BUN, AFP and IGF-I. Patients with disease control had significantly higher baseline IGF-1 levels 210 (185-232.5) ng/mL (p value<0.01) than did patients without disease control. Low basal IGF-1 levels were associated with advanced HCC, such as multiple tumors and advanced stage, and low IGF-1 levels predicted shorter TTP and overall survival in patients treated with TACE. The levels of serum IGF-1, expressed as continuous values, may be helpful for accurately assessing hepatic function and the prognostic stratification of patients with HCC.