Risks factors for severe pain after selective liver transarterial chemoembolization

Area of Science:

• Hepatobiliary Surgery
• Interventional Radiology
• Oncology

Background:

• Post-procedural pain is a frequent complication of transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).
• Treatment selectivity offers only partial prevention of pain.
• Identifying risk factors for severe pain is crucial for patient management.

Purpose of the Study:

• To determine the risk factors associated with severe post-procedural pain after selective TACE for HCC.
• To identify patient characteristics that predict the need for opioid analgesics.

Main Methods:

• Analysis of data from treatment-naïve patients undergoing their first selective TACE between January 2012 and June 2014.
• Uni- and multivariate logistic regression analysis to identify risk factors for severe pain (opioid requirement).
• Internal validation of a predictive model for opioid intake using bootstrapping.

Main Results:

• Opioid intake was required by 17% of patients.
• Univariate analysis showed associations with young age, doxorubicin dose, large HCC, absence of chronic liver disease, and alpha-fetoprotein levels.
• Multivariate analysis identified young age, absence of chronic liver disease, and higher doxorubicin dose fraction as significant predictors of opioid intake.

Conclusions:

• Selective TACE for HCC does not consistently prevent severe post-procedural pain.
• Young patients without chronic liver disease appear more susceptible to severe pain after TACE.
• A predictive model incorporating age, chronic liver disease status, and doxorubicin dose fraction demonstrated good predictive performance (AUC=0.751).