Skip to main content

Advertisement

SpringerLink
Log in

Predictive factors of severe abdominal pain during and after transarterial chemoembolization for hepatocellular carcinoma

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

A Correction to this article was published on 27 November 2020

This article has been updated

Abstract

Objectives

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.

Methods

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.

Results

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).

Conclusion

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.

Key Points

• 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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Change history

Abbreviations

BCLC:

Barcelona Clinics Liver Cancer

cTACE:

Conventional transarterial chemoembolization

EASL:

European Association for the Study of the Liver

EORTC:

European Organization for Research and Treatment of Cancer

HCC:

Hepatocellular carcinoma

OR:

Odds ratio

PES:

Post-embolization syndrome

TACE:

Transarterial chemoembolization

VAS:

Visual analog scale

References

  1. Forner A, Reig M, Bruix J (2018) Hepatocellular carcinoma. Lancet 391:1301–1314

    Article  Google Scholar 

  2. European Association for the Study of the Liver (2018) EASL Clinical Practice guidelines: management of hepatocellular carcinoma. J Hepatol 69:182–236

  3. Otto G, Herber S, Heise M et al (2006) Response to transarterial chemoembolization as a biological selection criterion for liver transplantation in hepatocellular carcinoma. Liver Transpl 12:1260–1267

    Article  Google Scholar 

  4. Ravaioli M, Grazi GL, Piscaglia F et al (2008) Liver transplantation for hepatocellular carcinoma: results of down-staging in patients initially outside the Milan selection criteria. Am J Transplant 8:2547–2557

    Article  CAS  Google Scholar 

  5. Llovet JM, Real MI, Montana X et al (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 359:1734–1739

    Article  Google Scholar 

  6. Lo CM, Ngan H, Tso WK et al (2002) Randomized controlled trial of transarterial Lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 35:1164–1171

    Article  CAS  Google Scholar 

  7. Llovet JM, Bruix J (2003) Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology 37:429–442

    Article  CAS  Google Scholar 

  8. Oliveri RS, Wetterslev J, Gluud C (2011) Transarterial (chemo) embolisation for unresectable hepatocellular carcinoma. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD004787.pub2CD004787

  9. Pomoni M, Malagari K, Moschouris H et al (2012) Post embolization syndrome in doxorubicin eluting chemoembolization with DC bead. Hepatogastroenterology 59:820–825

    CAS  PubMed  Google Scholar 

  10. Bouvier A, Ozenne V, Aube C et al (2011) Transarterial chemoembolisation: effect of selectivity on tolerance, tumour response and survival. Eur Radiol 21:1719–1726

    Article  Google Scholar 

  11. Golfieri R, Giampalma E, Renzulli M et al (2014) Randomised controlled trial of doxorubicin-eluting beads vs conventional chemoembolisation for hepatocellular carcinoma. Br J Cancer 111:255–264

    Article  CAS  Google Scholar 

  12. Leung DA, Goin JE, Sickles C, Raskay BJ, Soulen MC (2001) Determinants of postembolization syndrome after hepatic chemoembolization. J Vasc Interv Radiol 12:321–326

  13. Benzakoun J, Ronot M, Lagadec M et al (2017) Risks factors for severe pain after selective liver transarterial chemoembolization. Liver Int 37:583–591

    Article  CAS  Google Scholar 

  14. Lang EV, Benotsch EG, Fick LJ et al (2000) Adjunctive non-pharmacological analgesia for invasive medical procedures: a randomised trial. Lancet 355:1486–1490

    Article  CAS  Google Scholar 

  15. European Association for the Study of the Liver (2018) EASL Clinical Practice guidelines: management of alcohol-related liver disease. J Hepatol 69:154–181

  16. Yang H, Seon J, Sung PS et al (2017) Dexamethasone prophylaxis to alleviate postembolization syndrome after transarterial chemoembolization for hepatocellular carcinoma: a randomized, double-blinded, placebo-controlled study. J Vasc Interv Radiol 28:1503–1511 e1502

    Article  Google Scholar 

  17. Guo JG, Zhao LP, Rao YF et al (2018) Novel multimodal analgesia regimen improves post-TACE pain in patients with hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 17:510–516

    Article  Google Scholar 

  18. Jensen KJ, Alpini G, Glaser S (2013) Hepatic nervous system and neurobiology of the liver. Compr Physiol 3:655–665

    Article  Google Scholar 

  19. Novak DJ, Victor M (1974) The vagus and sympathetic nerves in alcoholic polyneuropathy. Arch Neurol 30:273–284

    Article  CAS  Google Scholar 

  20. Lammer J, Malagari K, Vogl T et al (2009) Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 33:41–52

    Article  Google Scholar 

  21. Khalaf MH, Shah RP, Green V et al (2020) Comparison of opioid medication use after conventional chemoembolization versus drug-eluting embolic chemoembolization. J Vasc Interv Radiol. https://doi.org/10.1016/j.jvir.2020.04.018

  22. Wang TC, Zhang ZS, Xiao YD (2020) Determination of risk factors for pain after transarterial chemoembolization with drug-eluting beads for hepatocellular carcinoma. J Pain Res 13:649–656

    Article  Google Scholar 

  23. Hatsiopoulou O, Cohen RI, Lang EV (2003) Postprocedure pain management of interventional radiology patients. J Vasc Interv Radiol 14:1373–1385

    Article  Google Scholar 

  24. Schupp CJ, Berbaum K, Berbaum M et al (2005) Pain and anxiety during interventional radiologic procedures: effect of patients’ state anxiety at baseline and modulation by nonpharmacologic analgesia adjuncts. J Vasc Interv Radiol 16:1585–1592

    Article  Google Scholar 

Download references

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Department of Radiology, APHP.Nord, Hôpital Beaujon, Clichy, Hauts-de-Seine, France

    Atanas Pachev, Lucas Raynaud, Luisa Paulatto, Marco Dioguardi Burgio, Vincent Roche, Carmela Garcia Alba, Annie Sibert, Matthieu Lagadec, Valérie Vilgrain & Maxime Ronot

  2. INSERM U1149, CRI, Paris, France

    Marco Dioguardi Burgio, Valérie Vilgrain & Maxime Ronot

  3. Université de Paris, Paris, France

    Vincent Roche, Catherine Paugam-Burtz, Valérie Vilgrain & Maxime Ronot

  4. Department of Anaesthesiology, APHP.Nord, Hôpital Beaujon, Clichy, Hauts-de-Seine, France

    Juliette Kavafyan-Lasserre & Catherine Paugam-Burtz

Authors
  1. Atanas Pachev
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lucas Raynaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luisa Paulatto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marco Dioguardi Burgio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Vincent Roche
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Carmela Garcia Alba
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Annie Sibert
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Matthieu Lagadec
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Juliette Kavafyan-Lasserre
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Catherine Paugam-Burtz
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Valérie Vilgrain
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Maxime Ronot
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maxime Ronot.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Maxime Ronot.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• diagnostic or prognostic study

• performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: The spelling of Lucas Raynaud’s name was incorrect.

Electronic supplementary material

ESM 1

(DOCX 161 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pachev, A., Raynaud, L., Paulatto, L. et al. Predictive factors of severe abdominal pain during and after transarterial chemoembolization for hepatocellular carcinoma. Eur Radiol 31, 3267–3275 (2021). https://doi.org/10.1007/s00330-020-07404-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-020-07404-5

Keywords

Search

Navigation