Predictive factors of severe abdominal pain during and after transarterial chemoembolization for hepatocellular carcinoma.
Analgesics, opioid
Chemoembolization, therapeutic
Liver cirrhosis
Pain, measurement
Pain, procedural
Journal
European radiology
ISSN: 1432-1084
Titre abrégé: Eur Radiol
Pays: Germany
ID NLM: 9114774
Informations de publication
Date de publication:
May 2021
May 2021
Historique:
received:
27
05
2020
accepted:
09
10
2020
revised:
03
09
2020
pubmed:
31
10
2020
medline:
16
4
2021
entrez:
30
10
2020
Statut:
ppublish
Résumé
To prospectively assess the frequency of severe abdominal pain during and after transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) using the visual analog scale (VAS), and to identify predictive factors. Ninety-eight TACE performed in 80 patients (mean 65 ± 12 years old, 60 men) were consecutively and prospectively included. Abdominal pain was considered severe if the VAS ≥ 30/100 after treatment administration, or if opioid analgesic (grades 2-3) intake was required during hospitalization. Patient and tumor characteristics as well as technical factors associated with severe pain were identified by binary logistic regression. The criterion for severe pain was met in 41/98 (42%) of procedures (peri-procedural pain 30/98 [31%] and opioid consumption during hospitalization 24/98 [25%]). Multivariate analysis identified age (odds ratio [OR] = 0.943 (95% confidence interval 0.895-0.994), p = 0.029), cirrhosis (OR = 0.284 (0.083-0.971), p = 0.045), and alcoholic liver disease (OR = 0.081 (0.010-0.659), p = 0.019) as negative predictive factors of severe abdominal pain. Severe abdominal pain occurred in or after 1/13 (8%), 8/34 (24%), 22/41 (54%), and 10/10 (100%) TACE sessions when none, one, two, and three of the protective factors were absent, respectively (p < 0.001). The area under the ROC curve of the combination of factors for the prediction of severe abdominal pain was 0.779 (CI 0.687-0.871). Severe abdominal pain was frequent during and after TACE revealing a clinically relevant and underestimated problem. A predictive model based on three readily available clinical variables suggests that young patients without alcoholic liver disease or cirrhosis could benefit from reinforced analgesia. • Severe abdominal pain occurs in 43% of TACE for HCC. • Younger age, absence of cirrhosis, and absence of alcoholic liver disease were identified as independent predictive factors of severe abdominal pain. • A simple combination of the three abovementioned features helped predict the occurrence of severe abdominal pain.
Identifiants
pubmed: 33123789
doi: 10.1007/s00330-020-07404-5
pii: 10.1007/s00330-020-07404-5
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3267-3275Commentaires et corrections
Type : ErratumIn
Références
Forner A, Reig M, Bruix J (2018) Hepatocellular carcinoma. Lancet 391:1301–1314
doi: 10.1016/S0140-6736(18)30010-2
European Association for the Study of the Liver (2018) EASL Clinical Practice guidelines: management of hepatocellular carcinoma. J Hepatol 69:182–236
Otto G, Herber S, Heise M et al (2006) Response to transarterial chemoembolization as a biological selection criterion for liver transplantation in hepatocellular carcinoma. Liver Transpl 12:1260–1267
doi: 10.1002/lt.20837
Ravaioli M, Grazi GL, Piscaglia F et al (2008) Liver transplantation for hepatocellular carcinoma: results of down-staging in patients initially outside the Milan selection criteria. Am J Transplant 8:2547–2557
doi: 10.1111/j.1600-6143.2008.02409.x
Llovet JM, Real MI, Montana X et al (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 359:1734–1739
doi: 10.1016/S0140-6736(02)08649-X
Lo CM, Ngan H, Tso WK et al (2002) Randomized controlled trial of transarterial Lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 35:1164–1171
doi: 10.1053/jhep.2002.33156
Llovet JM, Bruix J (2003) Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 37:429–442
doi: 10.1053/jhep.2003.50047
Oliveri RS, Wetterslev J, Gluud C (2011) Transarterial (chemo) embolisation for unresectable hepatocellular carcinoma. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004787.pub2CD004787
Pomoni M, Malagari K, Moschouris H et al (2012) Post embolization syndrome in doxorubicin eluting chemoembolization with DC bead. Hepatogastroenterology 59:820–825
pubmed: 22024228
Bouvier A, Ozenne V, Aube C et al (2011) Transarterial chemoembolisation: effect of selectivity on tolerance, tumour response and survival. Eur Radiol 21:1719–1726
doi: 10.1007/s00330-011-2118-2
Golfieri R, Giampalma E, Renzulli M et al (2014) Randomised controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma. Br J Cancer 111:255–264
doi: 10.1038/bjc.2014.199
Leung DA, Goin JE, Sickles C, Raskay BJ, Soulen MC (2001) Determinants of postembolization syndrome after hepatic chemoembolization. J Vasc Interv Radiol 12:321–326
Benzakoun J, Ronot M, Lagadec M et al (2017) Risks factors for severe pain after selective liver transarterial chemoembolization. Liver Int 37:583–591
doi: 10.1111/liv.13235
Lang EV, Benotsch EG, Fick LJ et al (2000) Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. Lancet 355:1486–1490
doi: 10.1016/S0140-6736(00)02162-0
European Association for the Study of the Liver (2018) EASL Clinical Practice guidelines: management of alcohol-related liver disease. J Hepatol 69:154–181
Yang H, Seon J, Sung PS et al (2017) Dexamethasone prophylaxis to alleviate postembolization syndrome after transarterial chemoembolization for hepatocellular carcinoma: a randomized, double-blinded, placebo-controlled study. J Vasc Interv Radiol 28:1503–1511 e1502
doi: 10.1016/j.jvir.2017.07.021
Guo JG, Zhao LP, Rao YF et al (2018) Novel multimodal analgesia regimen improves post-TACE pain in patients with hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 17:510–516
doi: 10.1016/j.hbpd.2018.08.001
Jensen KJ, Alpini G, Glaser S (2013) Hepatic nervous system and neurobiology of the liver. Compr Physiol 3:655–665
doi: 10.1002/cphy.c120018
Novak DJ, Victor M (1974) The vagus and sympathetic nerves in alcoholic polyneuropathy. Arch Neurol 30:273–284
doi: 10.1001/archneur.1974.00490340001001
Lammer J, Malagari K, Vogl T et al (2009) Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 33:41–52
doi: 10.1007/s00270-009-9711-7
Khalaf MH, Shah RP, Green V et al (2020) Comparison of opioid medication use after conventional chemoembolization versus drug-eluting embolic chemoembolization. J Vasc Interv Radiol. https://doi.org/10.1016/j.jvir.2020.04.018
Wang TC, Zhang ZS, Xiao YD (2020) Determination of risk factors for pain after transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma. J Pain Res 13:649–656
doi: 10.2147/JPR.S246197
Hatsiopoulou O, Cohen RI, Lang EV (2003) Postprocedure pain management of interventional radiology patients. J Vasc Interv Radiol 14:1373–1385
doi: 10.1097/01.RVI.0000085769.63355.24
Schupp CJ, Berbaum K, Berbaum M et al (2005) Pain and anxiety during interventional radiologic procedures: effect of patients’ state anxiety at baseline and modulation by nonpharmacologic analgesia adjuncts. J Vasc Interv Radiol 16:1585–1592
doi: 10.1097/01.RVI.0000185418.82287.72