Abstract
Purpose: Textbook Outcome (TO) is inclusive of quality indicators and it not been provided for trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).
Materials and Methods: Data on treatment-naïve HCC patients receiving TACE from 10 centers were reviewed. TO was defined as “no post-TACE grade 3–4 complications, no prolonged hospital stay (defined as a post-procedure stay ≤ 75th percentile of the median values from the total cohort), no 30-day mortality/readmission and the achievement of an objective response (OR) at post-TACE imaging.” Grade of adverse event was classified according to the Common Terminology Criteria for Adverse Events and short-term efficacy was assessed by response. Pooled estimates were calculated to account for hospital’s effect and risk-adjustment was applied to allow for diversity of patients in each center.
Results: A total of 1124 patients (2014–2018) fulfilling specific inclusion criteria were included. Baseline clinical features showed considerable heterogeneity (I2 > 0.75) across centers. TACE-related mortality was absent in 97.6%, readmission was not required after 94.9% of procedures, 91.5% of patients had no complication graded 3–4, 71.8% of patients did not require prolonged hospitalization, OR of the target lesion was achieved in 68.5%. Risk-adjustment showed that all indicators were achieved in 43.1% of patients, and this figure was similar across centers. The median overall survival for patients who achieved all indicators was 33.1 months, 11.9 months longer than for patients who did not.
Conclusions: A useful benchmark for TACE in HCC patients has been developed, which provides an indication of survival and allows for a comparison of treatment quality across different hospitals.
Materials and Methods: Data on treatment-naïve HCC patients receiving TACE from 10 centers were reviewed. TO was defined as “no post-TACE grade 3–4 complications, no prolonged hospital stay (defined as a post-procedure stay ≤ 75th percentile of the median values from the total cohort), no 30-day mortality/readmission and the achievement of an objective response (OR) at post-TACE imaging.” Grade of adverse event was classified according to the Common Terminology Criteria for Adverse Events and short-term efficacy was assessed by response. Pooled estimates were calculated to account for hospital’s effect and risk-adjustment was applied to allow for diversity of patients in each center.
Results: A total of 1124 patients (2014–2018) fulfilling specific inclusion criteria were included. Baseline clinical features showed considerable heterogeneity (I2 > 0.75) across centers. TACE-related mortality was absent in 97.6%, readmission was not required after 94.9% of procedures, 91.5% of patients had no complication graded 3–4, 71.8% of patients did not require prolonged hospitalization, OR of the target lesion was achieved in 68.5%. Risk-adjustment showed that all indicators were achieved in 43.1% of patients, and this figure was similar across centers. The median overall survival for patients who achieved all indicators was 33.1 months, 11.9 months longer than for patients who did not.
Conclusions: A useful benchmark for TACE in HCC patients has been developed, which provides an indication of survival and allows for a comparison of treatment quality across different hospitals.
Original language | English |
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Pages (from-to) | 449-459 |
Number of pages | 11 |
Journal | Cardiovascular and Interventional Radiology |
Volume | 46 |
Issue number | 4 |
Early online date | 27 Feb 2023 |
DOIs | |
Publication status | Published - Apr 2023 |
Keywords
- Hepatocellular carcinoma
- Trans-arterial chemoembolization
- Survival
- Complications
- Morbidity
- Textbook outcome
- mRECIST