Division of Vascular and Interventional Radiology, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Abdom Radiol (NY). 2022 Jan;47(1):416-422. doi: 10.1007/s00261-021-03306-2. Epub 2021 Oct 11.
To evaluate prognostic factors associated with peri-procedural (30 days) and short-term (90 days) mortality in the United States cohort of patients following emergent transarterial embolization for ruptured hepatocellular carcinoma.
Patients with ruptured hepatocellular carcinoma treated with emergent TAE between January 2001 and December 2019 were retrospectively identified (n = 24). Average age was 62 years (range, 23-78 year); 15 (62.5%) were men. Univariate and Cox proportional hazard modeling were used to determine independent predictors of overall survival (OS) following TAE. OS stratified by Model for End-Stage Liver Disease-Sodium score was assessed using Kaplan-Meier analysis.
Twenty-one patients (88%) died during a mean clinical follow-up period of 328 ± 139 days. MELD-Na score (HR 1.22 per 1-unit increase; 95% CI 1.06-1.46; p = 0.005) and pre-rupture ECOG PS score (HR 8.1; 95% CI 1.28-51.2; p = 0.026) were independent predictors of decreased overall survival. There was no significant association between overall survival and presence of cardiovascular co-morbidities (p = 0.60), hemorrhagic shock on presentation (p = 0.16), portal vein thrombus (p = 0.08), vasopressor support required (p = 0.79), intubation required (p = 0.40), acute kidney injury (p = 0.58), and number of packed red blood cell transfusions (p = 0.22). The median OS was 64 days. Median OS was significantly greater in patients with a MELD-Na score ≤ 16 as compared to those with a MELD-Na score > 16 (166.5 days vs 9 days, p = 0.011). Cumulative OS rates in those with a MELD-Na score ≤ 16 at 30, 60, 90, and 360 days were 79%, 64%, 64%, and 25%, respectively, vs 33%, 33%, 11%, and 0%, respectively, in those with a MELD-Na score > 16.
MELD-Na > 16 is associated with very high peri-procedural (67% at 30 days) and short-term (89% at 90 days) mortality in patients with ruptured HCC treated with emergent transarterial embolization. A better understanding of these prognostic factors may help guide treatment decisions and provide realistic expectations when counseling patients and their families.
评估与美国接受紧急经动脉栓塞治疗破裂肝细胞癌患者围手术期（30 天）和短期（90 天）死亡率相关的预后因素。
回顾性分析 2001 年 1 月至 2019 年 12 月期间接受紧急 TAE 治疗的破裂肝细胞癌患者（n=24）。平均年龄为 62 岁（范围 23-78 岁）；15 名（62.5%）为男性。采用单变量和 Cox 比例风险模型确定 TAE 后总生存率（OS）的独立预测因素。使用 Kaplan-Meier 分析评估按终末期肝病模型钠评分分层的 OS。
21 名患者（88%）在平均临床随访 328±139 天后死亡。MELD-Na 评分（每增加 1 个单位的 HR 为 1.22；95%CI 为 1.06-1.46；p=0.005）和破裂前 ECOG PS 评分（HR 8.1；95%CI 为 1.28-51.2；p=0.026）是降低总生存率的独立预测因素。总体生存率与心血管合并症的存在（p=0.60）、就诊时出血性休克（p=0.16）、门静脉血栓形成（p=0.08）、需要升压药支持（p=0.79）、需要插管（p=0.40）、急性肾损伤（p=0.58）和输血量（p=0.22）之间无显著相关性。中位 OS 为 64 天。MELD-Na 评分≤16 与 MELD-Na 评分>16 的患者相比，中位 OS 显著更长（166.5 天 vs 9 天，p=0.011）。MELD-Na 评分≤16 的患者在 30、60、90 和 360 天时的累积 OS 率分别为 79%、64%、64%和 25%，而 MELD-Na 评分>16 的患者分别为 33%、33%、11%和 0%。
在接受紧急经动脉栓塞治疗破裂肝细胞癌的患者中，MELD-Na>16 与围手术期（30 天内为 67%）和短期（90 天内为 89%）死亡率非常高相关。更好地了解这些预后因素可能有助于指导治疗决策，并在为患者及其家属提供咨询时提供现实的预期。
