Department of Radiology, APHP.Nord, Hôpital Beaujon, Clichy, Hauts-de-Seine, France.
INSERM U1149, CRI, Paris, France.
Eur Radiol. 2021 May;31(5):3267-3275. doi: 10.1007/s00330-020-07404-5. Epub 2020 Oct 29.
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.
使用视觉模拟评分（VAS）前瞻性评估肝癌（HCC）患者经动脉化疗栓塞（TACE）过程中和之后严重腹痛的频率，并确定预测因素。
连续前瞻性纳入 80 例 98 次 TACE 治疗（平均年龄 65±12 岁，60 例男性）。治疗后 VAS≥30/100 或住院期间需要使用阿片类镇痛剂（2-3 级）时，认为腹痛严重。通过二元逻辑回归确定与严重疼痛相关的患者和肿瘤特征以及技术因素。
98 次 TACE 中有 41 次（42%）符合严重疼痛标准（围手术期疼痛 30 次[31%]，住院期间使用阿片类药物 24 次[25%]）。多变量分析确定年龄（优势比[OR] = 0.943（95%置信区间 0.895-0.994），p = 0.029）、肝硬化（OR = 0.284（0.083-0.971），p = 0.045）和酒精性肝病（OR = 0.081（0.010-0.659），p = 0.019）为严重腹痛的阴性预测因素。在不存在、存在 1、2 和 3 个保护因素时，13 次（8%）、34 次（24%）、41 次（54%）和 10 次（100%）TACE 术中分别出现 1 次、8 次、22 次和 10 次严重腹痛（p<0.001）。严重腹痛预测因素联合的 ROC 曲线下面积为 0.779（95%CI 0.687-0.871）。
TACE 过程中和之后严重腹痛频繁发生，这是一个具有临床意义且被低估的问题。基于三个易于获得的临床变量的预测模型表明，无酒精性肝病或肝硬化的年轻患者可能受益于强化镇痛。
HCC 患者行 TACE 后，严重腹痛发生率为 43%。
年龄较小、无肝硬化和无酒精性肝病被确定为严重腹痛的独立预测因素。
上述三个特征的简单组合有助于预测严重腹痛的发生。
