Clinical Effect of the Acrylonitrile-Co-Methallyl Sulfonate Surface-Treated Membrane as a Cytokine Adsorption Therapy for Sepsis due to Acute Panperitonitis: A Retrospective Cohort Study

2020 ◽  
Vol 49 (3) ◽  
pp. 364-371
Author(s):  
Kentarou Hayashi ◽  
Yusuke Sasabuchi ◽  
Hiroki Matsui ◽  
Mikio Nakajima ◽  
Hiroyuki Ohbe ◽  
...  
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Primary Outcome ◽  
Clinical Effect ◽  
Primary Outcome Measure ◽  
Gastrointestinal Perforation ◽  
Disease Mechanism ◽  
Diagnosis Procedure Combination ◽  
Significant Difference

Introduction: Sepsis is a systemic inflammatory response syndrome caused by infectious diseases, with cytokines possibly having an important role in the disease mechanism. Acrylonitrile-co-methallyl sulfonate surface-treated (AN69ST) membrane is expected to improve the outcomes of patients with sepsis through cytokine adsorption. Objective: This study aimed to investigate the clinical effect of the AN69ST membrane in comparison to standard continuous renal replacement therapy (CRRT) membranes for panperitonitis due to lower gastrointestinal perforation. Methods: Using the Diagnosis Procedure Combination database, we identified adult patients with sepsis due to panperitonitis receiving any CRRT. Propensity score matching was used to compare patients who received CRRT with the AN69ST membrane (AN69ST group) and those who received CRRT with other membranes (non-AN69ST group). The primary outcome measure was in-hospital mortality. Results: A total of 528 and 1,445 patients were included in the AN69ST group and in the non-AN69ST group, respectively. Propensity score matching resulted in 521 pairs. There was no significant difference in in-hospital mortality (32.1 vs. 35.5%; p = 0.265) and 30-day mortality (41.3 vs. 42.8%, p = 0.074) between the AN69ST group and the non-AN69ST group. Conclusion: There is no significant difference in-hospital mortality between CRRT with the AN69ST membrane and CRRT with standard CRRT membranes for panperitonitis due to lower gastrointestinal perforation. These results indicate that the AN69ST membrane is not superior to the standard CRRT membrane.

scholarly journals Platelet transfusion and mortality in patients with sepsis-induced thrombocytopenia: a propensity score-matching analysis

2021 ◽  
Author(s):  
Aiming Zhou ◽  
Shanshan Wu ◽  
Qin Chen ◽  
Lili Chen ◽  
Jingye Pan
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Platelet Transfusion ◽  
Medical Information ◽  
Simplified Acute Physiology Score ◽  
Propensity Score Matching Analysis ◽  
Significant Difference ◽  
Failure Assessment ◽  
Mimic Iii

Abstract Thrombocytopenia is common among sepsis patients. Platelet transfusion is frequently administered to increase platelet counts but its clinical impacts remain unclear in sepsis-induced thrombocytopenia. The goal of this study was to explore the association between platelet transfusion and mortality in patients with sepsis-induced thrombocytopenia based on the Medical Information Mart for Intensive Care (MIMIC) III database. In this study, we included 1733 patients with sepsis-induced thrombocytopenia, and these patients were divided into two groups: platelet transfusion group (PT group) and no platelet transfusion group (NPT group). Propensity-score matching was used to reduce the imbalance. We found that patients in the PT group had a higher in-hospital mortality as compared with the NPT group. Furthermore, in the subgroup of age (>60 years), gender (female), sequential organ failure assessment score (≤8), simplified acute physiology score (≤47), platelet count (>27/nL), congestive heart failure, platelet transfusion was associated with increased in-hospital mortality. However, there was no significant difference in the 90-day mortality and the length of ICU stays (LOS-ICU) between these two groups. All these results remain stable after adjustment for confounders and in the comparisons after propensity score matching. In conclusion, platelet transfusion was associated with increased in-hospital mortality in patients with sepsis-induced thrombocytopenia.

Primary or secondary Bentall-De Bono procedure: are the outcomes worse?

2019 ◽  
Vol 27 (4) ◽  
pp. 271-277
Author(s):  
Ameya Kaskar ◽  
Deepak V Bohra ◽  
Rahul Rao K ◽  
Varun Shetty ◽  
Devi Shetty
Keyword(s):  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Survival Rates ◽  
Median Sternotomy ◽  
Postoperative Mortality ◽  
Mortality And Morbidity ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Background The aim of this study was to compare the outcomes of a primary and secondary Bentall-De Bono procedure. Methods From 2008 to 2015 (8-year period), 308 patients underwent a Bentall-De Bono procedure in our institute. The mean age was 43 ± 13 years and 80% were men. Twenty-eight patients had prior cardiac surgery through a median sternotomy (group 1) and 280 underwent a primary Bentall-De Bono procedure (group 2). Various preoperative and perioperative parameters were analyzed before and after propensity-score matching. Results Before propensity-score matching, patients undergoing a secondary Bentall-De Bono procedure had a worse preoperative profile, as indicated by a higher EuroSCORE II ( p < 0.0001), with hospital mortality in group 1 of 14% (4/28) and 5% (14/280) in group 2 ( p = 0.069). After propensity-score matching, there was no significant difference in EuroSCORE II ( p = 0.922) or hospital mortality ( p = 0.729). After adjusting for the different variables, repeat sternotomy could not be identified as an independent predictor of postoperative mortality or morbidity. Survival at the end of 1 and 5 years in both groups showed no significant differences before or after propensity-score matching ( p = 0.328 and p = 0.356, respectively). In Cox multivariable regression analysis, reoperation was not identified as an independent factor for survival before ( p = 0.559) or after propensity-score matching ( p = 0.365). Conclusion A secondary Bentall-De Bono procedure can be performed with acceptable mortality and morbidity, and with midterm survival rates comparable to those of a primary Bentall-De Bono procedure.

scholarly journals In-Hospital Mortality After Blood Purification With and Without Acrylonitrile-Co-Methallyl Sulfonate Surface-Treated Membrane for Pneumonia-Associated Sepsis: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Kentaro Hayashi ◽  
Yusuke Sasabuchi ◽  
Hiroki Matsui ◽  
Mikio Nakajima ◽  
Hiroyuki Ohbe ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mortality Rate ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Control Group ◽  
Diagnosis Procedure Combination ◽  
Inpatient Database

Abstract Background: Cytokine removal therapy is one of the available therapies for sepsis. Acrylonitrile-co-methallyl sulfonate surface-treated (AN69ST, sepXiris®) membrane has cytokine adsorption capacity and has been widely used for treating sepsis in Japan. The aim of this study was to compare the effects of continuous renal replacement therapy (CRRT) with AN69ST membrane and conventional CRRT for patients with pneumonia-associated sepsis.Methods: We conducted a retrospective cohort study using the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan. We identified adult patients who were hospitalized due to pneumonia and received CRRT within 2 days of admission from September 2014 to March 2017. We included patients who received CRRT with AN69ST membrane within 2 days of admission in the treatment group (AN69ST group); those who received CRRT with other membranes within 2 days of admission were included in the control group (non-AN69ST group). Propensity score matching was used to compare in-hospital mortality between the two groups.Results: Eligible patients (n=2,393) were categorized into the AN69ST group (n=631) or the non-AN69ST group (n=1,762). The overall in-hospital mortality rate in pneumonia patients treated with CRRT was 38.9%. Propensity score matching created a matched cohort of 545 pairs of patients. The in-hospital mortality rate was significantly lower in the AN69ST group than in the non-AN69ST group (35.8 vs. 41.8%, p=0.046).Conclusion: Our data suggest that CRRT with the AN69ST membrane was associated with a significantly lower in-hospital mortality than CRRT with standard membranes among patients with pneumonia-associated sepsis.

Therapeutic Impact of Initial Treatment for Chlamydia trachomatis Among Patients With Pelvic Inflammatory Disease: A Retrospective Cohort Study Using a National Inpatient Database in Japan

2018 ◽  
Vol 69 (2) ◽  
pp. 316-322
Author(s):  
Daisuke Shigemi ◽  
Hiroki Matsui ◽  
Kiyohide Fushimi ◽  
Hideo Yasunaga
Keyword(s):  
Chlamydia Trachomatis ◽  
Propensity Score ◽  
Pelvic Inflammatory Disease ◽  
Propensity Score Matching ◽  
Inflammatory Disease ◽  
Initial Treatment ◽  
Primary Outcome ◽  
Control Group ◽  
Short Term ◽  
Significant Difference

Abstract Background Pelvic inflammatory disease (PID) is common among women of reproductive age and can be complicated by tuboovarian abscess (TOA), which is a serious and potentially life-threatening disease. However, recent mortality rates from PID on hospital admission and the short-term therapeutic usefulness of initial treatment for Chlamydia trachomatis remain unknown. Methods Using the Diagnosis Procedure Combination database, we identified patients who were diagnosed with PID on admission from July 2010 to March 2016 in Japan. We excluded patients who were pregnant, had cancer, or had missing data. Propensity score–adjusted analyses were performed to compare short-term outcomes between patients administered initial treatment for C. trachomatis and those without this treatment. The primary outcome was surgical intervention (laparotomy, laparoscopic surgery, and/or drainage procedure) during hospitalization. Results In total, 27841 eligible patients were identified. Of these patients, 2463 (8.8%) had TOA on admission. Mortality during hospitalization was 0.56% and 0.28% in the groups without and with TOA, respectively. Propensity score matching created 6149 pairs. A significant difference was observed in the primary outcome between those receiving initial treatment for C. trachomatis and the control group after propensity score matching (11.5% vs 13.4%; risk difference, −1.9%; 95% confidence interval, −3.1 to −0.7). The group that received initial treatment for C. trachomatis also had a significantly lower mortality rate. Conclusions In this retrospective nationwide study, initial treatment for C. trachomatis among hospitalized patients diagnosed with PID had clinical benefits in terms of improved short-term outcomes.

Abstract TP434: The Effect of Therapeutic Modalities on Outcomes in Patients With Subarachnoid Hemorrhage: a Nationwide Study Using the Japanese Diagnosis Procedure Combination Database From The J-aspect Study

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Ryota Kurogi ◽  
Akiko Kada ◽  
Kunihiro Nishimura ◽  
Satoru Kamitani ◽  
Ataru Nishimura ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Mixed Model ◽  
Diagnosis Procedure Combination ◽  
Nationwide Study ◽  
Mixed Model Analysis ◽  
Propensity Score Matching Analysis ◽  
Training Institutions

Background and Purpose: The effects of the clipping or coiling treatment on patients with subarachnoid hemorrhage (SAH) remain elusive. We performed a nationwide study to compare the effects of clipping with those of coiling in patients with SAH by using the Japanese Diagnosis Procedure Combination (DPC) database. Materials and methods: We analyzed data obtained from patients who were hospitalized for SAH in 427 certified training institutions of the Japan Neurosurgical Society between April 2012 and March 2013. Outcomes regarding in-hospital mortality, modified Rankin Scale (mRS) scores, cerebral infarction, and complications were compared between clipping and coiling groups using mixed model analysis and propensity score matching analysis. In addition, we conducted a questionnaire-based survey regarding comprehensive stroke center (CSC) capabilities. The questionnaire elicited data regarding the availability of personnel, diagnostic techniques, specific expertise, infrastructure, and educational components recommended for CSCs in 749 professional training institutions on February 2011. Results: Data obtained from a total of 5214 patients with SAH (3624 clipping, 1590 coiling) were analyzed. Mixed model analysis (OR=1.30, P=0.013) and propensity score matching analysis (OR=1.35, P=0.022) revealed that the in-hospital mortality was significantly higher in the coiling group, while both analyses revealed that the discharge mRS was not significantly different between groups. Clipping of intracranial aneurysms (IAs) and operating rooms staffed 24/7 were available in 91.5% and 60.4% of 749 hospitals, respectively. Coiling of IAs and interventional services coverage 24/7 were available in 48.1% and 37.3% of 749 hospitals, respectively. Conclusions: This study demonstrated that clipping is superior to coiling for SAH patients. In Japan, the number of hospitals where coiling is available is still considerably lower than the number of hospitals where of clipping is available. The differences among hospitals may be associated with the increased in-hospital mortality in the patients undergoing coiling. This nationwide database study can complement the findings of prospective clinical trials, and reflect real-world practice.

scholarly journals The Prevalence and Impact of Arrhythmias in Hospitalized Patients with Sickle Cell Disorders: A Large Database Analysis

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 5-6
Author(s):  
Ankita Kapoor ◽  
Samarthkumar Thakkar ◽  
Lucas Battel ◽  
Harsh P. Patel ◽  
Nikhil Agrawal ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Logistic Regression ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Sickle Cell ◽  
Left Ventricular ◽  
Hospital Charges ◽  
Significant Difference ◽  
Sickle Cell Disorders

Introduction: Sickle cell disorders (SCD) is associated with progressive dysfunction of vital organs, including the cardiovascular system. While the development of pulmonary hypertension and left ventricular dysfunction have been previously studied, the burden of arrhythmias in SCD patients remains largely unknown. Thus, we aim to describe and analyze the prevalence and impact of arrhythmias in hospitalized adult patients with SCD and their impact in patient-oriented outcomes. Methods: We identified incident arrhythmias in patients with SCD in the National Inpatient Sample (NIS) database in 2 years (2016-2017), using ICD-10 codes. We compared major patient characteristics, outcomes, and economic impact between groups of SCD patients with and without documented arrhythmias. A logistic regression model was used to control for age, sex, race, admission type, hospital characteristics, and relevant comorbidities. To increase statistical robustness, propensity-score matching for age, sex, income, and comorbidities was used to match 1144 SCD patients with arrhythmia and 1144 patients without. Results: Among inpatients with SCD in the database, 5,930 of 174,450 patients with SCD had documented arrhythmias (3.4%). The arrhythmia group consisted mostly of patients' sickle cell disease (5,650; 95%), while 245 had sickle cell trait, and 35 were classified as having other sickle cell disorders. Individuals in the arrhythmia group were significantly older (mean age 41.3, SD 14.1) than those with no arrhythmia (mean age 31.5, SD 10.3). Further, arrhythmia group had higher prevalence of hypertension (44.2% vs 19.1%, p&lt;0.001), congestive heart failure (25.8% vs 4.1%, p&lt;0.001), chronic kidney disease (24.0% vs 5.6%, p&lt;0.001), valvular heart disease (9.3% vs 1.5%, p&lt;0.001), myocardial infarction (4.1% vs 1.25%, p&lt;0.001), type 2 diabetes mellitus (3.5% vs 1.7%, p&lt;0.001), and pulmonary hypertension (3.5% vs 1.2%, p&lt;0.001). When looking at major outcomes, after adjusting for confounders, arrhythmias were positively associated with all cause in-hospital mortality with an adjusted OR of 53.6 (95% CI 44.3, 65.1). After propensity-matching (Table 1), the arrhythmia group had a higher rate of all-cause in-hospital mortality (6.12% vs 0.35%, p&lt;0.001), higher median length of stay (6.8 days vs 5.8 days, p&lt;0.001), and mean total hospital charges ($13,441 vs $10,255, p&lt;0.001). There was no statistically significant difference in the rate of stroke between both groups. Conclusions: The presence of arrhythmias in patients with SCD was associated with markedly increased all cause in-hospital mortality, even after adjusting for confounders via logistic regression and propensity-score matching analyses. Despite a relatively low overall prevalence of 3.4% among this large inpatient cohort, this data suggests that arrhythmias may confer an important excess disease burden in SCD patients, including higher mortality. Intuitively, arrythmias confer higher mortality in patients with chronic disorders and multiple cardiovascular risks, whether this is specific to SCD deserves further study. Also, studies are needed to better understand the occurrence particularly in relation to active vaso-occlusive crisis and to evaluate whether SCD individuals with arrhythmias could potentially benefit from more intensive monitoring and/or better cardiovascular disease control. Disclosures No relevant conflicts of interest to declare.

Abstract 13351: Association of Atrial Fibrillation With In-hospital Mortality Among Patients With Takotsubo Cardiomyopathy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Qiying Dai ◽  
Abhishek Bose ◽  
Pengyang Li ◽  
PENG CAI ◽  
Douglas Laidlaw
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Mortality Rate ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Mortality Rates ◽  
Primary Diagnosis ◽  
Propensity Score Matching Analysis ◽  
Significant Difference

Introduction: Takotsubo cardiomyopathy (TC), characterized by transient left ventricular dysfunction, is known to be precipitated by sudden physical or emotional stress. Atrial fibrillation (AF) is a common arrhythmia and its presence increases mortality in patients with chronic underlying diseases. Furthermore, multiple studies have suggested that in TC patients, underlying AF correlates with a higher in-hospital mortality. However, these studies were constrained by either a disproportionate percentage of AF patients or lack of risk factor matching. To systematically explore the association between TC and AF, we decided to perform a propensity score matching analysis. Methods: We performed a retrospective cohort analysis using the ICD-10 codes for a primary diagnosis of TC from the 2016 National Inpatient Sample. To adjust for underlying risk factors a multivariable logistic regression model was employed followed by a propensity score matching analysis for the AF group and the non-AF group. A similar analysis method was followed for the subset of patients with paroxysmal AF. In-hospital mortality rates were compared between the two groups. Results: Out of the total 3139 patients with a primary diagnosis of TC, 433 (13.7%) had AF and 243 (7.7%) had paroxysmal AF. In the unmatched group, patients with AF appeared to be older (74.7 vs. 65.3 years, P<0.001) and more likely to have comorbidities like diabetes mellitus (24.0% vs 19.2%, P=0.024), chronic kidney disease (15.7% vs 7.6%, P<0.001) and obstructive sleep apnea (8.8% vs 4.9%, P=0.002). On multivariable logistic regression, in-hospital mortality was higher in the AF group (3.9% vs 1.3%, P< 0.001). However, after propensity score matching, there was no significant difference in the mortality rate between the two groups (3.7% vs 1.9%, P=0.082). Similarly, on logistic regression followed by propensity matching for patients with paroxysmal AF, no significant difference was noted for in-hospital mortality rates (3.3% vs 1.3%, P=0.112). Conclusions: In patients with TC, the presence of underlying AF had no effect on the in-hospital mortality rate.

scholarly journals Intracameral Bevacizumab Versus Sub-Tenon’s Mitomycin C as Adjuncts to Trabeculectomy: 3-Year Results of a Prospective Randomized Study

2021 ◽  
Vol 10 (10) ◽  
pp. 2054
Author(s):  
Gerasimos Kopsinis ◽  
Dimitrios Tsoukanas ◽  
Dimitra Kopsini ◽  
Theodoros Filippopoulos
Keyword(s):  
Mitomycin C ◽  
Primary Outcome ◽  
Randomized Study ◽  
Primary Outcome Measure ◽  
Complication Rates ◽  
Filtration Surgery ◽  
Significant Difference ◽  
Exfoliative Glaucoma

Conjunctival wound healing determines success after filtration surgery and the quest for better antifibrotic agents remains active. This study compares intracameral bevacizumab to sub-Tenon’s mitomycin C (MMC) in trabeculectomy. Primary open-angle or exfoliative glaucoma patients were randomized to either bevacizumab (n = 50 eyes) or MMC (n = 50 eyes). The primary outcome measure was complete success, defined as Intraocular Pressure (IOP) > 5 mmHg and ≤ 21 mmHg with a minimum 20% reduction from baseline without medications. Average IOP and glaucoma medications decreased significantly in both groups at all follow-up points compared to baseline (p < 0.001), without significant difference between groups at 3 years (IOP: bevacizumab group from 29 ± 9.4 to 15 ± 3.4 mmHg, MMC group from 28.3 ± 8.7 to 15.4 ± 3.8 mmHg, p = 0.60; Medications: bevacizumab group from 3.5 ± 0.9 to 0.5 ± 1, MMC group from 3.6 ± 0.7 to 0.6 ± 1.1, p = 0.70). Complete success, although similar between groups at 3 years (66% vs. 64%), was significantly higher for bevacizumab at months 6 and 12 (96% vs. 82%, p = 0.03; 88% vs. 72%, p = 0.04, respectively) with fewer patients requiring medications at months 6, 9 and 12 (4% vs. 18%, p = 0.03; 6% vs. 20%, p = 0.04; 8% vs. 24%, p = 0.03, respectively). Complication rates were similar between groups. In conclusion, intracameral bevacizumab appears to provide similar long-term efficacy and safety results as sub-Tenon’s MMC after trabeculectomy.

scholarly journals Empiric use of anticoagulation in hospitalized patients with COVID-19: a propensity score-matched study of risks and benefits

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Bo Yu ◽  
Victor Perez Gutierrez ◽  
Alex Carlos ◽  
Gregory Hoge ◽  
Anjana Pillai ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Major Bleeding ◽  
Risk Estimation ◽  
Large Population ◽  
Invasive Mechanical Ventilation ◽  
Bleeding Risk ◽  
Hospitalized Patients ◽  
Significant Difference

Abstract Background Hospitalized patients with COVID-19 demonstrate a higher risk of developing thromboembolism. Anticoagulation (AC) has been proposed for high-risk patients, even without confirmed thromboembolism. However, benefits and risks of AC are not well assessed due to insufficient clinical data. We performed a retrospective analysis of outcomes from AC in a large population of COVID-19 patients. Methods We retrospectively reviewed 1189 patients hospitalized for COVID-19 between March 5 and May 15, 2020, with primary outcomes of mortality, invasive mechanical ventilation, and major bleeding. Patients who received therapeutic AC for known indications were excluded. Propensity score matching of baseline characteristics and admission parameters was performed to minimize bias between cohorts. Results The analysis cohort included 973 patients. Forty-four patients who received therapeutic AC for confirmed thromboembolic events and atrial fibrillation were excluded. After propensity score matching, 133 patients received empiric therapeutic AC while 215 received low dose prophylactic AC. Overall, there was no difference in the rate of invasive mechanical ventilation (73.7% versus 65.6%, p = 0.133) or mortality (60.2% versus 60.9%, p = 0.885). However, among patients requiring invasive mechanical ventilation, empiric therapeutic AC was an independent predictor of lower mortality (hazard ratio [HR] 0.476, 95% confidence interval [CI] 0.345–0.657, p < 0.001) with longer median survival (14 days vs 8 days, p < 0.001), but these associations were not observed in the overall cohort (p = 0.063). Additionally, no significant difference in mortality was found between patients receiving empiric therapeutic AC versus prophylactic AC in various subgroups with different D-dimer level cutoffs. Patients who received therapeutic AC showed a higher incidence of major bleeding (13.8% vs 3.9%, p < 0.001). Furthermore, patients with a HAS-BLED score of ≥2 had a higher risk of mortality (HR 1.482, 95% CI 1.110–1.980, p = 0.008), while those with a score of ≥3 had a higher risk of major bleeding (Odds ratio: 1.883, CI: 1.114–3.729, p = 0.016). Conclusion Empiric use of therapeutic AC conferred survival benefit to patients requiring invasive mechanical ventilation, but did not show benefit in non-critically ill patients hospitalized for COVID-19. Careful bleeding risk estimation should be pursued before considering escalation of AC intensity.

scholarly journals Chemoembolization Plus Radiotherapy versus Chemoembolization Plus Sorafenib for the Treatment of Hepatocellular Carcinoma Invading the Portal Vein: A Propensity Score Matching Analysis

Cancers ◽  
2020 ◽  
Vol 12 (5) ◽  
pp. 1116 ◽  
Author(s):  
Hee Ho Chu ◽  
Jin Hyoung Kim ◽  
Ju Hyun Shim ◽  
Sang Min Yoon ◽  
Pyeong Hwa Kim ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Propensity Score ◽  
Portal Vein ◽  
Propensity Score Matching ◽  
Combined Treatment ◽  
Correct Selection ◽  
Advanced Hepatocellular Carcinoma ◽  
Entire Study ◽  
Treatment Type ◽  
Significant Difference

A combination of transarterial chemoembolization (TACE) plus sorafenib or radiotherapy (RT) has demonstrated efficacy in patients with advanced hepatocellular carcinoma (HCC). Here, the two combined treatment approaches were compared in patients with HCC and portal vein tumor thrombus (PVTT). Data from 307 patients treated with TACE plus RT (n = 203) or TACE plus sorafenib (n = 104) as first-line treatment for HCC with PVTT were retrospectively evaluated. Using the propensity model to correct selection bias, 87 patients were included from each treatment group. During follow up (median, 12 months) in the entire study population, the median progression-free survival (PFS) and overall survival (OS) were significantly longer in the TACE plus RT group than in the TACE plus sorafenib group (6.5 vs. 4.3 months, respectively; p = 0.017 and 16.4 vs. 12 months, respectively; p = 0.007). Following propensity score matching, the median PFS and OS in the two groups showed no statistically significant difference. Multivariable analysis found no significant association between PFS or OS and the treatment type. In conclusion, this retrospective study of data from patients with advanced HCC with PVTT shows that PFS and OS did not differ significantly in patients treated with TACE plus RT and TACE plus sorafenib.

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