Predictive model for acute abdominal pain after transarterial chemoembolization for liver cancer

Abstract

BACKGROUND Transarterial chemoembolization (TACE) is the first-line treatment for patients with unresectable liver cancer; however, TACE is associated with postembolization pain. AIM To analyze the risk factors for acute abdominal pain after TACE and establish a predictive model for postembolization pain. METHODS From January 2018 to September 2018, all patients with liver cancer who underwent TACE at our hospital were included. General characteristics; clinical, imaging, and procedural data; and postembolization pain were analyzed. Postembolization pain was defined as acute moderate-to-severe abdominal pain within 24 h after TACE. Logistic regression and a classification and regression tree were used to develop a predictive model. Receiver operating characteristic curve analysis was used to examine the efficacy of the predictive model. RESULTS We analyzed 522 patients who underwent a total of 582 TACE procedures. Ninety-seven (16.70%) episodes of severe pain occurred. A predictive model built based on the dataset from classification and regression tree analysis identified known invasion of blood vessels as the strongest predictor of subsequent performance, followed by history of TACE, method of TACE, and history of abdominal pain after TACE. The area under the receiver operating characteristic curve was 0.736 [95% confidence interval (CI): 0.682-0.789], the sensitivity was 73.2%, the specificity was 65.6%, and the negative predictive value was 92.4%. Logistic regression produced similar results by identifying age [odds ratio (OR) = 0.971; 95%CI: 0.951-0.992; P = 0.007), history of TACE (OR = 0.378; 95%CI: 0.189-0.757; P = 0.007), history of abdominal pain after TACE (OR = 6.288; 95%CI: 2.963-13.342; P < 0.001), tumor size (OR = 1.978; 95%CI: 1.175-3.330; P = 0.01), multiple tumors (OR = 2.164; 95%CI: 1.243-3.769; P = 0.006), invasion of blood vessels (OR = 1.756; 95%CI: 1.045-2.950; P = 0.034), and TACE with drug-eluting beads (DEB-TACE) (OR = 2.05; 95%CI: 1.260-3.334; P = 0.004) as independent predictive factors for postembolization pain. CONCLUSION Blood vessel invasion, TACE history, TACE with drug-eluting beads, and history of abdominal pain after TACE are predictors of acute moderate-to-severe pain. The predictive model may help medical staff to manage pain.

Creating and Testing a Model to Predict Postoperative Discomfort in Patients with Hepatocellular Carcinoma Receiving Transarterial Chemoembolisation

“…Therefore, high-quality external validation is required to verify the validity and generalisability of this prediction model in different populations. Second, some risk factors, which were demonstrated to contribute to postembolisation pain in previous studies, such as chronic liver disease and psychological factors, were not investigated in this research (3,9). Thus, future studies should develop a more robust prediction model that includes more potential contributing risk factors.…”

“…Among the malignant tumors with high morbidity and death rates, notably in Asia and Africa, is primary hepatocellular carcinoma (HCC) (1). According to reports, HCC is the second most frequent cause of cancer-related deaths in China and the sixth most frequent carcinoma (2,3). Most cases of HCC in China are already in the intermediate and advanced stages at diagnosis, precluding traditional radical surgery as an effective intervention (4).…”

“…Most cases of HCC in China are already in the intermediate and advanced stages at diagnosis, precluding traditional radical surgery as an effective intervention (4). For unresectable HCCs, transarterial chemoembolisation (TACE) is the most widely used treatment, playing an important role in prolonging patients' survival and improving their qual-ity of life (QoL) (3). It has been reported that over 100,000 patients with HCC undergo TACE in China every year (3).…”

“…For unresectable HCCs, transarterial chemoembolisation (TACE) is the most widely used treatment, playing an important role in prolonging patients' survival and improving their qual-ity of life (QoL) (3). It has been reported that over 100,000 patients with HCC undergo TACE in China every year (3).…”

Construction and Validation of Prediction Model of Severe Abdominal Pain Post-Transarterial Chemoembolization in Patients with HBV-Associated Primary Liver Cancer

“…TACE can increase the concentration of chemotherapy drugs exposed to tumors by injecting large doses of chemical drugs locally to the tumor target lesions, promoting tumor embolization infarction or necrosis [ 10 , 11 ]. Postembolic syndromes, including acute abdominal pain, nausea, and vomiting, are common after TACE, which is an important reason for prolonged hospital stay, decreased treatment effect, and interruption of treatment [ 12 ]. At present, clinical studies have reported that the incidence and severity of abdominal pain vary greatly in different cohorts of HCC patients after TACE treatment [ 13 , 14 ].…”