Koonsiripaiboon Preeyamas, Ruamtawee Witchakorn, Simasingha Nitipon, Tanasoontrarat Wasu, Claimon Torpong, Sethasine Supatsri
Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Dusit 10300, Bangkok, Thailand.
Clinical Research Center, Research Facilitation Division, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Dusit 10300, Bangkok, Thailand.
World J Gastroenterol. 2025 Aug 21;31(31):109630. doi: 10.3748/wjg.v31.i31.109630.
Hepatocellular carcinoma (HCC) is a major health concern in Thailand, with most patients diagnosed at the intermediate stage. Transarterial chemoembolization (TACE) is the standard treatment; however, postembolization syndrome (PES) remains a common complication. Although both dexamethasone (DEXA) and N-acetylcysteine (NAC) have shown efficacy in reducing PES, no study has directly compared their effects.
To compare the incidence of PES between DEXA and NAC in intermediate-stage HCC patients undergoing conventional TACE (cTACE).
A randomized, double-blind, controlled trial was conducted at two tertiary hospitals in Thailand from November 2024 to April 2025. Eligible HCC patients (aged 18-70 years) were randomized (1:1) to receive either NAC (150 mg/kg/hour loading dose, followed by 50 mg/kg over 4 hours, then 6.25 mg/kg/ hour for 48 hours post-cTACE) or DEXA (8 mg IV 1 hour before cTACE). cTACE was performed by blinded interventional radiologists. The primary outcome was PES occurrence within 48 hours, assessed using South West Oncology Group toxicity coding and the Common Terminology Criteria for Adverse Events. The secondary outcomes were post-cTACE liver decompensation and the dynamic changes in the albumin-bilirubin (ALBI) score.
A total of 56 intermediate-stage HCC patients were included (DEXA, = 28; NAC, = 28). Most had preserved liver function, with 92.9% classified as Child-Pugh A. The maximum tumor size was 6.2 cm, and 85.7% had multiple lesions. Additionally, 39 patients (69.6%) met the beyond up-to-7 criteria. Overall, 27 patients (48.2%) developed PES. After adjusting for confounding factors, the NAC group had a significantly lower incidence of PES than the DEXA group (32.1% 64.3%; adjusted odds ratio = 0.17, 95% confidence interval: 0.03-0.87, = 0.033). Only two patients (3.6%) developed post-cTACE liver decompensation. Furthermore, 51.8% patients experienced worsening ALBI scores within 48 hours post-procedure; however, the rate of ALBI score worsening did not significantly differ between the groups.
Compared with DEXA, NAC significantly reduces the incidence of PES, regardless of its impact on liver function recovery. Therefore, NAC is a preferable option for reducing PES in Barcelona Clinic Liver Cancer-B stage HCC patients with preserved liver function.
肝细胞癌（HCC）是泰国主要的健康问题，大多数患者在中期被诊断出来。经动脉化疗栓塞术（TACE）是标准治疗方法；然而，栓塞后综合征（PES）仍然是一种常见的并发症。尽管地塞米松（DEXA）和N-乙酰半胱氨酸（NAC）在降低PES方面均显示出疗效，但尚无研究直接比较它们的效果。
比较接受传统TACE（cTACE）的中期HCC患者中DEXA和NAC之间PES的发生率。
2024年11月至2025年4月在泰国的两家三级医院进行了一项随机、双盲、对照试验。符合条件的HCC患者（年龄18 - 70岁）被随机分为两组（1:1），分别接受NAC（150mg/kg/小时负荷剂量，随后在4小时内给予50mg/kg，然后在cTACE后48小时内给予6.25mg/kg/小时）或DEXA（cTACE前1小时静脉注射8mg）。cTACE由不知情的介入放射科医生进行。主要结局是48小时内PES的发生情况，使用西南肿瘤学组毒性编码和不良事件通用术语标准进行评估。次要结局是cTACE后肝功能失代偿以及白蛋白-胆红素（ALBI）评分的动态变化。
共纳入56例中期HCC患者（DEXA组28例；NAC组28例）。大多数患者肝功能良好，92.9%被归类为Child-Pugh A级。最大肿瘤大小为6.2cm，85.7%有多个病灶。此外，39例患者（69.6%）符合超过7项标准。总体而言，27例患者（48.2%）发生了PES。在调整混杂因素后
