scholarly journals Clinical Characteristics and Outcomes of Acute Lung Injury Caused by Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: A Retrospective Cohort Study from a Single Institution in China

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Liang-jie Fang ◽  
Lu-yan Chen ◽  
Jun-hui Sun ◽  
Jian-ying Zhou

Background. Acute lung injury (ALI) is a rare but life-threatening pulmonary complication of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). The aim of this study was to characterize the common risk factors, clinical features, imaging findings, treatments, and outcomes of acute lung injury caused by TACE. Methods. A retrospective study was performed on all TACE-associated ALI cases that were diagnosed at authors’ hospital from January 2015 to June 2018. Results. The study included 14 ALI cases where the mean age of patients was 60.9±11.7 years (range 41-82 years), with a mean onset time of 2.4±1.6 d after TACE. Of the 14 patients, 8 patients (57.1%) developed acute respiratory distress syndrome (ARDS). 7 patients (50%) had underlying chronic respiratory disease and hepatic arteriovenous fistula was detected in 6 patients (42.6%), both of which were significantly higher than control group (P<0.05). Dyspnea (92.9%) was the most common symptoms. Pleural effusion (64.3%), diffuse pulmonary infiltration (42.9%), and accumulation of Lipiodol in lung field (42.9%) were frequent radiologic abnormalities. 11 patients (78.6%) achieved remission after treatment, and the 30-day mortality rate was approximately 21.4%. Patient’s median survival time after the development of ALI was merely 4.3 months, which was obviously worse than control group (4.3 months vs. 13.5 months, P<0.05). Conclusion. This study illustrates that TACE-associated ALI is a rare pulmonary complication with a high mortality rate. We infer that pulmonary Lipiodol embolization might be one of the main causes of TACE-associated ALI. Thus, HCC patients who are at high risk should be closely evaluated and monitored during TACE to avoid such potentially fatal complication.

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Yao Liu ◽  
Yuxin Li ◽  
Fangyuan Gao ◽  
Qun Zhang ◽  
Xue Yang ◽  
...  

Background. To compare the efficacies of transcatheter arterial chemoembolization (TACE) with radiofrequency ablation (RFA) (TACE + RFA) and TACE alone in patients with hepatocellular carcinoma (HCC) and macrovascular invasion (MVI). Methods. In total, 664 patients having HCC with MVI were included. Of these patients, 141 were treated with TACE + RFA, 254 with TACE alone, and 269 with supportive therapy (control group). The overall survival (OS) was compared among these groups. Propensity score matching (PSM) was performed for balancing the characteristics of the three groups. Results. After one-to-one PSM, the 12-month OS rates were higher in the TACE and TACE + RFA groups than in the control group (p=0.0009 and p=0.0017, respectively). Furthermore, higher 12-month OS rates were observed in the TACE + RFA group than in the TACE group (p=0.0192). The 12-month OS rates of patients were remarkably higher in α-fetoprotein (AFP) < 400 ng/ml, tumor < 3, tumor diameter < 5 cm, or portal vein tumor thrombosis (PVTT) group who were treated with TACE + RFA than in those who were treated with TACE (p=0.0122, p=0.0090, p=0112, and p=0.0071, respectively). Conclusions. TACE + RFA provides a superior survival outcome than TACE alone in HCC patients, especially in AFP <400 ng/ml, tumor <3, tumor diameter <5 cm, or PVTT group.


2020 ◽  
pp. 030089162094502
Author(s):  
Yong Xie ◽  
Huan Tian ◽  
Hua Xiang

Objective: To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) plus sorafenib compared with TACE plus placebo for hepatocellular carcinoma (HCC) using meta-analytical techniques. Methods: A search of PubMed, EMBASE, and Cochrane Library databases were done from inception to December 27, 2019. Published trials including a treatment group receiving TACE + sorafenib and a control group receiving TACE + placebo with data for at least 1-year survival or tumor response or time to progression were included. Results: Our study suggested that there was no evidence that TACE plus sorafenib was associated with a lower risk of disease progression compared with TACE plus placebo for treatment of HCC (hazard ratio 0.94 [95% confidence interval (CI), 0.84–1.05]), and no significant difference for treatment of HCC compared with TACE plus placebo in terms of 0.5-, 1-, 1.5-, and 2-year survival rates (risk ratio [RR] 1.01 [95% CI, 0.97–1.05]; RR 1.00 [95% CI, 0.92–1.08], RR 1.04 [95% CI, 0.89–1.23], RR 0.98 [95% CI, 0.72–1.34], respectively). The meta-analysis also showed that TACE + sorafenib seemed to have no significant difference for treatment of HCC compared with TACE + placebo in terms of complete response, partial response, stable disease, progressive disease, overall response rate, and disease control rate. There was an increased incidence of fatigue of grade 3/4 and elevation of aspartate aminotransferase and alanine aminotransferase of grade 3/4 in patients receiving TACE plus sorafenib compared with those receiving TACE plus placebo. Conclusions: There is no additive benefit of TACE plus sorafenib compared to TACE plus placebo for HCC.


2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Wanfu Lin ◽  
Huan Wang ◽  
Maofeng Zhong ◽  
Shasha Yu ◽  
Shasha Zhao ◽  
...  

Transcatheter arterial chemoembolization (TACE) is one of the effective treatment methods for hepatocellular carcinoma (HCC) in middle and late phases. However, TACE-induced hypoxia may promote the angiogenesis and section of some cytokines, such as IL-8, and, thereby, lead to tumor metastasis. Therefore, we investigated the effect of Jiedu Recipe (JR), which has been demonstrated as an effective Traditional Chinese Medicine (TCM) recipe on HCC, on TACE-induced cytokines upregulation and hypoxia-induced angiogenesis. A total of 88 hepatocellular carcinoma (HCC) patients treated with TACE were enrolled and divided into a JR group or control group. TACE induced significant increases of neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), IL-1β, IL-2R, IL-6, and IL-8. JR treatment significantly inhibited the elevation of IL-8 compared with control. In vitro, JR significantly inhibited the hypoxia-induced overexpression of IL-8, HIF-1α, and VEGF mRNA in Huh 7 cells. ELISA assay demonstrated the effect of JR on IL-8 expression. Both hypoxia and IL-8 may promote angiogenesis which was suppressed by JR. Western blot showed that IL-8 upregulated the expression of phosphorylation of AKT, ERK, NF-κB, and VEGFR, which were inhibited by JR. On the other hand, effects of IL-8 on the increase of p-AKT and p-ERK were also blocked by LY294002 and U0126, respectively. In conclusion, our results indicated that JR may inhibit hypoxia-induced angiogenesis through suppressing IL-8/HIF-1α/PI3K and MAPK/ERK pathways after TACE in HCC patients.


2017 ◽  
Vol 35 (3) ◽  
pp. 239
Author(s):  
Suthisa Temtap ◽  
Rungtip Udomvisatson ◽  
Kittikorn Nilmanat

Objective: To test the effect of bed rest time reduction on back pain and vascular complication in patients with hepatocellular carcinoma after transcatheter arterial chemoembolization (TACE).Material and Method: This study was two-group randomized controlled trial. A total of 54 patients with hepatocellular carcinoma, receiving TACE enrolled from October 2015-November 2016, were purposively selected and randomly assigned equally to receive either 6 hours (the control group) or 3 hours (the experimental group) of bed rest after TACE was achieved. Patients in both groups were evaluated back pain by the pain Numerical Rating Scale and vascular complications by Hematoma Formation and Bleeding Scale. Data were analyzed by chi-square test and Mann-Whitney U-test.Results: The mean total score on back pain in the experimental group was significantly lower than that of the control group at 6 and 8 hours following TACE (p-value< 0.000). No vascular complications was found in both the groups.Conclusion: Reducing bed rest time from 6 hours to 3 hours of patients following TACE can decrease the severity of back pain and has no effect on the incidence of vascular complications.


2002 ◽  
Vol 46 (3) ◽  
pp. 229
Author(s):  
Seung Hun Ryu ◽  
Hyung Jin Shim ◽  
Byung Kook Kwak ◽  
Gi Hyun Kim ◽  
Hwa Yeon Lee ◽  
...  

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