Safety profile of transarterial chemoembolization therapy in elderly patients with hepatocellular carcinoma

Yıl 2025, Cilt: 50 Sayı: 3, 744 - 751, 30.09.2025

Ümit Karaogullarindan , Anıl Delik

https://doi.org/10.17826/cumj.1666988

Öz

This study explores the safety of ransarterial chemoembolization (TACE) in elderly Hepatocellular carcinoma (HCC) patients, aiming to clarify its suitability and identify risk factors for serious adverse events, ultimately aiding clinical decisions in geriatric oncology.
Materials and Methods: This retrospective study included patients over 18 years of age who were newly diagnosed with HCC based on histopathological confirmation or established non-invasive radiological criteria. All participants received TACE as their initial treatment. Pre- and post-procedural imaging was obtained using either dynamic magnetic resonance imaging (MRI) or triphasic computed tomography (CT).
Results: One hundred twenty-nine patients aged over 18 years with HCC were included in our study. General adverse events were reported in 58.3% of patients in Group A and 66.7% in Group B, while serious adverse events occurred in 33.3% versus 41.7%, respectively. Among patients who experienced at least one serious adverse event after TACE, univariate analysis revealed significant predictive associations with female sex, smoking history, presence of diabetes mellitus, a Child-Pugh classification above A, and BCLC stage B disease. Multivariate analysis revealed that female gender and BCLC stage B were independent risk factors associated with the development of serious adverse events after TACE.
Conclusion: This study revealed that the safety profiles of TACE were comparable between the elderly and younger populations, showing no discernible differences. It was also seen that age had no predictive value for serious adverse events.

Anahtar Kelimeler

Transarterial chemoembolization , hepatocellular carcinoma , safety , eldery , side effects

Etik Beyan

Ethical approval was obtained by Çukurova University Ethics Committee on July 22, 2022 (institutional review board and clinical trial number 124-17).

Hepatosellüler karsinomlu yaşlı hastalarda transarteriyel kemoembolizasyon tedavisinin güvenlik profili

Öz

Amaç: Bu çalışma, yaşlı Hepatoselüler karsinomalı (HCC) hastalarda transarteriyel kemoembolizasyonun (TACE) güvenliğini incelemeyi, uygulanabilirliğini netleştirmeyi ve ciddi advers olaylar için risk faktörlerini belirlemeyi hedeflemektedir. Böylelikle bu bulgular, geriatri onkolojisinde klinik karar verme sürecine katkıda bulunacaktır.
Gereç ve Yöntem: Bu retrospektif çalışmaya, histopatolojik doğrulama veya yerleşik non-invaziv radyolojik kriterlere göre yeni tanı almış ve yaşı 18'in üzerinde olan HCC hastaları dahil edilmiştir. Tüm hastalara ilk tedavi olarak TACE uygulanmıştır. İşlem öncesi ve sonrası görüntüleme, dinamik manyetik rezonans görüntüleme (MRG) veya üç fazlı bilgisayarlı tomografi (BT) ile gerçekleştirilmiştir.
Bulgular: Çalışmaya HCC tanısı olan ve yaşı 18’in üzerinde olan toplam 129 hasta dahil edilmiştir. Genel advers olaylar, Grup A’da %58,3 ve Grup B’de %66,7 oranında bildirilirken; ciddi advers olaylar sırasıyla %33,3 ve %41,7 oranında gözlenmiştir. TACE sonrası en az bir ciddi advers olay yaşayan hastalarda yapılan univaryant analizde, kadın cinsiyet, sigara öyküsü, diyabet varlığı, Child-Pugh sınıflamasının A üzerinde olması ve BCLC evresi B olması (ile anlamlı ilişki saptanmıştır. Multivaryant analizde ise, kadın cinsiyet ve BCLC evresi B, TACE sonrası ciddi advers olay gelişimi ile bağımsız risk faktörleri olarak belirlenmiştir.
Sonuç: Bu çalışma, yaşlı ve genç popülasyonlar arasında TACE’nin güvenlik profillerinin karşılaştırılabilir olduğunu ortaya koymuş, yaşın ciddi advers olaylar açısından öngörücü bir değer taşımadığını göstermiştir.

Anahtar Kelimeler

Transarteriyel kemoembolizasyon , hepatosellüler karsinom , güvenlik , yaşlılık , yan etkiler

Kaynakça

• Ioannou GN, Splan MF, Weiss NS, McDonald GB, Beretta L, Lee SP. Incidence and predictors of hepatocellular carcinoma in patients with cirrhosis. Clin Gastroenterol Hepatol. 2007;5:938-45.
• Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in globocan 2012. Int J Cancer. 2015;136:359-86.
• Jemal A, Ward EM, Johnson CJ, Cronin KA, Ma J, Ryerson AB et al. Annual report to the nation on the status of cancer, 1975-2014, featuring survival. J Natl Cancer Inst. 2017;109:djx030.
• Llovet JM, Bruix J. Systematic review of randomized trials for unresectable hepatocellular carcinoma: chemoembolization improves survival. Hepatology. 2003;37:429-42.
• Sieghart W, Hucke F, Peck-Radosavljevic M. Transarterial chemoembolization: modalities, indication, and patient selection. J. Hepatol. 2015;62:1187-95.
• Blanc JF, Debaillon-Vesque A, Roth G, Barbare JC, Baumann AS, Boige V et al. Hepatocellular carcinoma: french ıntergroup clinical practice guidelines for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, AFEF, SIAD, SFR/FRI). Clin. Res. Hepatol. Gastroenterol. 2021;45:101590.
• Lencioni R, de Baere T, Soulen MC, Rilling WS, Geschwind JF. Lipiodol transarterial chemoembolization for hepatocellular carcinoma: a systematic review of efficacy and safety data. Hepatology. 2016;64:106-16.
• Raoul JL, Forner A, Bolondi L, Cheung TT, Kloeckner R, de Baere T. Updated use of tace for hepatocellular carcinoma treatment: how and when to use it based on clinical evidence. Cancer Treat Rev. 2019;72:28–36.
• European association for the study of the liver electronic address: [e-mail]; european association for the study of the liver. easl clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69:182-236.
• Lee SH, Choi HC, Jeong SH, Lee KH, Chung JI, Park YS et al. Hepatocellular carcinoma in older adults: clinical features, treatments, and survival. J Am Geriatr Soc. 2011;59:241-50.
• Roth GS, Teyssier Y, Abousalihac M, Seigneurin A, Ghelfi J, Sengel C et al. Idarubicin vs doxorubicin in transarterial chemoembolization of intermediate stage hepatocellular carcinoma. World J. Gastroenterol. 2020;26:324-34.
• Repetto L, Fratino L, Audisio RA, Venturino A, Gianni W, Vercelli M et al. Comprehensive geriatric assessment adds information to eastern cooperative oncology group performance status in elderly cancer patients: an ıtalian group for geriatric oncology study. J Clin Oncol. 2002;20:494-502.
• Roth GS, Hernandez O, Daabek N, Brusset B, Teyssier Y, Ghelfi J et al. Safety and efficacy of transarterial chemoembolization in elderly patients with ıntermediate hepatocellular carcinoma. Cancers. 2022;14:1634.
• Nishikawa H, Kita R, Kimura T, Ohara Y, Takeda H, Sakamoto A et al. Transcatheter arterial chemoembolization for intermediate-stage hepatocellular carcinoma: clinical outcome and safety in elderly patients. J Cancer. 2014;5:590-7.
• Cohen MJ, Levy I, Barak O, Bloom AI, Fernández‐Ruiz M, Di Maio M et al. Trans-arterial chemo-embolization is safe and effective for elderly advanced hepatocellular carcinoma patients: results from an international database. Liver Int. 2014;34:1109-17.
• Cohen MJ, Bloom AI, Barak O, Klimov A, Nesher T, Shouval D et al. Transarterial chemo-embolization is safe and effective for very elderly patients with hepatocellular carcinoma. World J Gastroenterol. 2013;19:2521-8.