Textbook Outcome After Trans-arterial Chemoembolization for Hepatocellular Carcinoma

Mosconi, Cristina; O'Rourke, Joanne; Kloeckner, Roman; Sturm, Lukas; Golfieri, Rita; Celsa, Ciro; Fateen, Waleed; Odisio, Bruno C; Garanzini, Enrico Matteo; Peck-Radosavljevic, Markus; Borghi, Alberto; Ma, Yuk Ting; Stoehr, Fabian; Bettinger, Dominik; Giuffrida, Paolo; Aithal, Guruprasad P; Lin, Yuan-Mao; Spreafico, Carlo; Giampalma, Emanuela; Johnson, Philip; Cucchetti, Alessandro

Abstract

Purpose
Textbook Outcome (TO) is inclusive of quality indicators and it not been provided for trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).

Materials and Methods
Data on treatment-naïve HCC patients receiving TACE from 10 centers were reviewed. TO was defined as "no post-TACE grade 3-4 complications, no prolonged hospital stay (defined as a post-procedure stay ≤ 75th percentile of the median values from the total cohort), no 30-day mortality/readmission and the achievement of an objective response (OR) at post-TACE imaging." Grade of adverse event was classified according to the Common Terminology Criteria for Adverse Events and short-term efficacy was assessed by response. Pooled estimates were calculated to account for hospital's effect and risk-adjustment was applied to allow for diversity of patients in each center.

Results
A total of 1124 patients (2014-2018) fulfilling specific inclusion criteria were included. Baseline clinical features showed considerable heterogeneity (I  > 0.75) across centers. TACE-related mortality was absent in 97.6%, readmission was not required after 94.9% of procedures, 91.5% of patients had no complication graded 3-4, 71.8% of patients did not require prolonged hospitalization, OR of the target lesion was achieved in 68.5%. Risk-adjustment showed that all indicators were achieved in 43.1% of patients, and this figure was similar across centers. The median overall survival for patients who achieved all indicators was 33.1 months, 11.9 months longer than for patients who did not.

Conclusion
A useful benchmark for TACE in HCC patients has been developed, which provides an indication of survival and allows for a comparison of treatment quality across different hospitals.

Citation

Mosconi, C., O'Rourke, J., Kloeckner, R., Sturm, L., Golfieri, R., Celsa, C., …Cucchetti, A. (2023). Textbook Outcome After Trans-arterial Chemoembolization for Hepatocellular Carcinoma. CardioVascular and Interventional Radiology, 46, 449-459. https://doi.org/10.1007/s00270-023-03375-4

• Journal Article Type: Article
• Acceptance Date: Jan 27, 2023
• Online Publication Date: Feb 27, 2023
• Publication Date: 2023-04
• Deposit Date: Jul 19, 2023
• Print ISSN: 0174-1551
• Electronic ISSN: 1432-086X
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 46
• Pages: 449-459
• DOI: https://doi.org/10.1007/s00270-023-03375-4
• Keywords: mRECIST, Trans-arterial chemoembolization, Morbidity, Hepatocellular carcinoma, Survival, Textbook outcome, Complications
• Public URL: https://nottingham-repository.worktribe.com/output/18804897
• Publisher URL: https://link.springer.com/article/10.1007/s00270-023-03375-4