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| Trends and outcomes of transarterial chemoembolization in hepatocellular carcinoma: a national survey |
| Khalid Mumtaz, Nishi Patel, Rohan M Modi, Vihang Patel, Alice Hinton, James Hanje, Sylvester M Black and Somashaker Krishna |
Columbus, USA
Author Affiliations: Division of Gastroenterology, Hepatology and Nutrition (Mumtaz K, Hanje J and Krishna S), Department of Internal Medicine (Patel N, Modi RM and Patel V), and Department of Surgery (Black SM), The Ohio State University Wexner Medical Center, Columbus, OH, USA; Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA (Hinton A)
Corresponding Authors: Khalid Mumtaz, MD, MSc, Assistant Professor, Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University Wexner Medical Center, 395 West 12th Avenue, 2nd Floor, Columbus, OH 43210, USA (Tel: +1-614-2824675; Email: Khalid.Mumtaz@osumc.edu) |
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Abstract BACKGROUND: Transarterial chemoembolization (TACE) is a palliative procedure frequently used in patients with advanced hepatocellular carcinoma (HCC). We examined the national inpatient trends of TACE and related outcomes in the United States over the last decade.
METHODS: We utilized the National Inpatient Sample (2002 to 2012) and performed trend analyses of TACE for HCC in all adult patients (age >18 years). Multivariate analyses for the outcomes of in-hospital “procedure-related complications” (PRCs) and “post-procedure complications” (PPCs) were performed. We also compared early (2002 to 2006) and late (2007 to 2012) eras by multivariate analyses to identify predictors of complications, healthcare resource utilization and mortality.
RESULTS: Overall, 19058 patients underwent TACE for HCC where PRCs and PPCs were seen in 24.2% and 17.6% of patients, respectively. The overall trends in the use of TACE (P<0.001) and associated PRCs (P=0.006) were observed to be increasing. There was less mortality [adjusted Odds ratio (aOR): 0.58; 95% CI: 0.41, 0.82], reduced length of hospital stay (-1.87 days; 95% CI: -2.77, -0.97) and increased hospital charges ($19232; 95% CI: 11013, 27451) in the late era. Additionally, there was increased mortality (aOR: 4.07; 95% CI: 2.96, 5.59), PRCs (aOR: 3.21; 95% CI: 2.56, 4.02), and PPCs (aOR: 2.70; 95% CI: 2.11, 3.46) among patients with coagulopathy.
CONCLUSIONS: There is an increasing trend of TACE utilization in HCC. However, the outcomes are worse in patients with coagulopathy. Although PRCs have increased, mortality has decreased in recent years. These findings should be considered during TACE evaluation in patients with HCC.
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2017, Vol. 16 
