Krieg Sarah, Essing Tobias, Krieg Andreas, Roderburg Christoph, Luedde Tom, Loosen Sven H
Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Medical Faculty of Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany.
Paracelsus Medical University, Klinikum Nürnberg, 90419 Nürnberg, Germany.
Cancers (Basel). 2022 Apr 22;14(9):2088. doi: 10.3390/cancers14092088.
(1) Background: Transarterial chemoembolization (TACE) is a minimally invasive procedure, characterized by the selective occlusion of tumor-feeding hepatic arteries, via injection of an embolizing agent and an anticancer drug. It represents a standard of care for intermediate-stage hepatocellular carcinoma (HCC), and it is also increasingly performed in cholangiocarcinoma (CCA), as well as in liver metastases. Apart from the original method, based on intra-arterial infusion of a liquid drug followed by embolization, newer particle-based TACE procedures have been introduced recently. As yet, comprehensive data on current trends of TACE, as well as its in-hospital mortality in Germany, which could help to further improve outcome following TACE, are missing. (2) Methods: Based on standardized hospital discharge data, provided by the German Federal Statistical Office from 2010 to 2019, we aimed at systematically evaluating current clinical developments and in-hospital mortality related to TACE in Germany. (3) Results: A total of 49,595 individual cases undergoing TACE were identified within the observation period. The overall in-hospital mortality was 1.00% and significantly higher in females compared to males (1.12 vs. 0.93%; p < 0.001). We identified several post-interventional complications, such as liver failure (51.49%), sepsis (33.87%), renal failure (23.9%), and liver abscess (15.87%), which were associated with a significantly increased in-hospital mortality. Moreover, in-hospital mortality significantly differed between the underlying indications for TACE (HCC: 0.83%, liver metastases: 1.22%, and CCA: 1.40%), as well as between different embolization agents (liquid embolization: 0.80%, loaded microspheres: 0.92%, spherical particles: 1.54%, and non-spherical particles: 2.84%), for which we observed large geographic differences in their frequency of use. Finally, in-hospital mortality was significantly increased in centers with a low annual TACE case volume (<15 TACE/year: 2.08% vs. >275 TACE/year: 0.45%). (4) Conclusion: Our data provide a systematic overview of indications and embolization methods for TACE in Germany. We identified a variety of factors, such as post-interventional complications, the embolization method used, and the hospitals’ annual case volume, which are associated with an increased in-hospital mortality following TACE. These data might help to further reduce the mortality of this routinely performed local-ablative procedure in the future.
（1）背景：经动脉化疗栓塞术（TACE）是一种微创手术，其特点是通过注射栓塞剂和抗癌药物选择性地阻塞肿瘤供血的肝动脉。它是中期肝细胞癌（HCC）的标准治疗方法，在胆管癌（CCA）以及肝转移瘤中也越来越多地应用。除了基于动脉内注入液体药物随后进行栓塞的原始方法外，最近还引入了更新的基于颗粒的TACE程序。然而，目前关于TACE的当前趋势及其在德国的院内死亡率的综合数据缺失，而这些数据有助于进一步改善TACE后的治疗效果。（2）方法：基于德国联邦统计局2010年至2019年提供的标准化医院出院数据，我们旨在系统评估德国与TACE相关的当前临床进展和院内死亡率。（3）结果：在观察期内共识别出49595例接受TACE的个体病例。总体院内死亡率为1.00%，女性显著高于男性（1.12%对0.93%；p<0.001）。我们识别出了几种介入后并发症，如肝衰竭（51.49%）、败血症（33.87%）、肾衰竭（23.9%）和肝脓肿（15.87%），这些并发症与院内死亡率显著增加相关。此外，TACE的潜在适应症之间（HCC：0.83%，肝转移瘤：1.22%，CCA：1.40%）以及不同栓塞剂之间（液体栓塞：0.80%，载药微球：0.92%，球形颗粒：1.54%，非球形颗粒：2.84%）的院内死亡率存在显著差异，我们观察到它们的使用频率存在较大的地理差异。最后，年度TACE病例量较低的中心（<15例TACE/年：2.08%对>275例TACE/年：0.45%）的院内死亡率显著增加。（4）结论：我们的数据提供了德国TACE的适应症和栓塞方法的系统概述。我们识别出了多种因素，如介入后并发症、使用的栓塞方法以及医院的年度病例量，这些因素与TACE后院内死亡率增加相关。这些数据可能有助于未来进一步降低这种常规进行的局部消融手术的死亡率。
