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CC BY-NC-ND 4.0 · Journal of Clinical Interventional Radiology ISVIR 2023; 07(01): 027-033
DOI: 10.1055/s-0042-1745775
Original Article

Frailty as a Predictor of Complications and Transplant-Free Survival after Transarterial Chemoembolization of Hepatocellular Carcinoma

Rana Rabei
1   Department of Interventional Radiology, University of California, San Francisco, San Francisco, California, United States
,
Parmede Vakil
1   Department of Interventional Radiology, University of California, San Francisco, San Francisco, California, United States
,
Bradley King
1   Department of Interventional Radiology, University of California, San Francisco, San Francisco, California, United States
,
R. Peter Lokken
1   Department of Interventional Radiology, University of California, San Francisco, San Francisco, California, United States
,
Michael Heller
1   Department of Interventional Radiology, University of California, San Francisco, San Francisco, California, United States
,
Nicholas Fidelman
1   Department of Interventional Radiology, University of California, San Francisco, San Francisco, California, United States
,
Maureen Kohi
2   Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, United States
› Author Affiliations Funding None.
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Abstract

Purpose To determine the association between frailty, 30-day complications, rehospitalization, and transplant-free survival (TFS) following conventional and drug-eluting bead transarterial chemoembolization.

Materials and Methods A retrospective analysis was performed on a cohort of 125 patients with treatment-naïve hepatocellular carcinoma who underwent conventional or drug-eluting beads chemoembolization at our institution between 2014 and 2015. Liver function parameters, Barcelona clinic liver cancer tumor stage, and all components of the five-item modified frailty index (mFI-5) were used to determine the patient's frailty status. Key end points included severe (grade 3 or above) adverse events of chemoembolization, 30-day rehospitalization rates, and TFS. Logistic regression analysis was performed on conventional predictors of postoperative complications after chemoembolization. Median survival was estimated and compared using the Kaplan–Meier's estimator and log-rank test.

Results Among 125 patients who underwent first-time chemoembolization, higher frailty score was an independent predictor of both 30-day hospital readmission and severe liver toxicity (p = 0.01 and p = 0.03, respectively) on multivariate logistic regression analysis. Each point increase in mFI-5 conferred a threefold or twofold increase in the risk of experiencing 30-day rehospitalization or postoperative severe adverse events, respectively. At the data censor date, patients with mFI-5 score ≥ 2 had decreased overall TFS (28.1 vs. 39.8 months, p = 0.03).

Conclusion Increasing frailty as determined by mFI-5 is an independent predictor of 30-day complications and lower TFS following chemoembolization.

Keywords

oncology - frailty - TACE

Ethical approval

The article was exempted from an ethical committee approval.


Note

For this type of study, formal consent is not required. This single-center, retrospective cohort study is Health Insurance Portability and Accountability Act compliant and was approved by the Institutional Review Board at our institution.




Publication History

Article published online:
17 May 2022

© 2022. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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