Prediction of postembolization syndrome after transarterial chemoembolization of hepatocellular carcinoma and its impact on prognosis

Author:

Roehlen Natascha12ORCID,Stoehr Fabian3,Müller Lukas3,Luxenburger Hendrik1ORCID,Gairing Simon J.4,Reincke Marlene1,Schultheiss Michael12ORCID,Berisha Floriona3,Weinmann Arndt4ORCID,Foerster Friedrich4ORCID,Marquardt Jens U.5ORCID,Thimme Robert1ORCID,Galle Peter R.4ORCID,Bettinger Dominik1ORCID,Kloeckner Roman36ORCID

Affiliation:

1. Department of Medicine II, Gastroenterology, Hepatology, Endocrinology and Infectious Diseases, Freiburg University Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany

2. Berta-Ottenstein-Programme, Faculty of Medicine, University of Freiburg, Freiburg, Germany

3. Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany

4. Department of Internal Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany

5. Department of Medicine I, University Center Schleswig-Holstein-Campus Lübeck, Lübeck, Germany

6. Department of Diagnostic and Interventional Radiology, University of Lübeck, Lübeck, Germany

Abstract

Background: Postembolization syndrome (PES) represents the most frequent complication after transarterial chemoembolization (TACE) in patients with HCC. Given the vague definition as a symptom complex comprising abdominal pain, fever, and nausea, PES is diagnosed in heterogeneous patient cohorts with symptoms ranging from mild pain to severe deterioration of their general condition. This study aimed to evaluate predictive factors and the prognostic impact of PES with regard to different severity grades. Methods: A total of 954 patients treated with TACE for HCC at the University Medical Centres Mainz and Freiburg were included in this study. PES disease severity was graded as mild, moderate, or severe according to a predefined combination of symptoms. Logistic regression models were used to identify independent predictors of PES. The prognostic impact of PES was evaluated by competing risk analyses considering liver transplantation as a competing risk. Results: PES occurred in 616 patients (64.5%), but only 56 patients (5.9%) had severe PES, defined as moderate to severe abdominal pain requiring opioids in combination with fever and nausea. The largest tumor diameter was the strongest independent predictor of PES (OR = 1.21, 95% CI = 1.13–1.28), and severe PES (OR = 1.23, 95% CI = 1.14–1.33, p < 0.0001). Presence of liver cirrhosis was protective against PES (OR = 0.48, 95% CI = 0.27–0.84, p = 0.01). Furthermore, PES was independently associated with an impaired disease control rate (OR = 0.33, 95% CI = 0.16–0.69, p = 0.003) and severe PES with poor overall survival (subdistribution HR = 1.53, 95% CI = 0.99–2.36, p = 0.04). Conclusions: Tumor size and absence of liver cirrhosis are predictors of severe PES and associated with impaired prognosis in HCC patients after TACE.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Hepatology

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