BACKGROUND Hepatocellular carcinoma(HCC)is a major health concern in Thailand,with most patients diagnosed at the intermediate stage.Transarterial chemoembolization(TACE)is the standard treatment;however,postembolizat...BACKGROUND Hepatocellular carcinoma(HCC)is a major health concern in Thailand,with most patients diagnosed at the intermediate stage.Transarterial chemoembolization(TACE)is the standard treatment;however,postembolization syndrome(PES)remains a common complication.Although both dexamethasone(DEXA)and N-acetylcysteine(NAC)have shown efficacy in reducing PES,no study has directly compared their effects.AIM To compare the incidence of PES between DEXA and NAC in intermediate-stage HCC patients undergoing conventional TACE(cTACE).METHODS A randomized,double-blind,controlled trial was conducted at two tertiary hospitals in Thailand from November 2024 to April 2025.Eligible HCC patients(aged 18-70 years)were randomized(1:1)to receive either NAC(150 mg/kg/hour loading dose,followed by 50 mg/kg over 4 hours,then 6.25 mg/kg/hour for 48 hours post-cTACE)or DEXA(8 mg IV 1 hour before cTACE).cTACE was performed by blinded interventional radiologists.The primary outcome was PES occurrence within 48 hours,assessed using South West Oncology Group toxicity coding and the Common Terminology Criteria for Adverse Events.The secondary outcomes were post-cTACE liver decompensation and the dynamic changes in the albumin-bilirubin(ALBI)score.RESULTS A total of 56 intermediate-stage HCC patients were included(DEXA,n=28;NAC,n=28).Most had preserved liver function,with 92.9%classified as Child-Pugh A.The maximum tumor size was 6.2 cm,and 85.7%had multiple lesions.Additionally,39 patients(69.6%)met the beyond up-to-7 criteria.Overall,27 patients(48.2%)developed PES.After adjusting for confounding factors,the NAC group had a significantly lower incidence of PES than the DEXA group(32.1%vs 64.3%;adjusted odds ratio=0.17,95%confidence interval:0.03-0.87,P=0.033).Only two patients(3.6%)developed post-cTACE liver decompensation.Furthermore,51.8%patients experienced worsening ALBI scores within 48 hours post-procedure;however,the rate of ALBI score worsening did not significantly differ between the groups.CONCLUSION Compared with DEXA,NAC significantly reduces the incidence of PES,regardless of its impact on liver function recovery.Therefore,NAC is a preferable option for reducing PES in Barcelona Clinic Liver Cancer-B stage HCC patients with preserved liver function.展开更多
BACKGROUND Conventional transarterial chemoembolization(cTACE)is the current standard treatment for intermediate-stage hepatocellular carcinoma(HCC).Postembolization syndrome(PES)is complex clinical syndrome that pres...BACKGROUND Conventional transarterial chemoembolization(cTACE)is the current standard treatment for intermediate-stage hepatocellular carcinoma(HCC).Postembolization syndrome(PES)is complex clinical syndrome that presents as fever,abdominal pain,nausea,and vomiting.Either dexamethasone(DEXA)or Nacetylcysteine(NAC)is used to prevent PES;however,the synergistic effect of their combined therapy for preventing PES and liver decompensation has not been determined.AIM To evaluate the efficacy of DEXA and NAC combination in preventing PES and liver decompensation after cTACE.METHODS Patients with Barcelona Clinic Liver Cancer stage A or B HCC who were scheduled for TACE were prospectively enrolled.All patients were randomly stratified to receive NAC and DEXA or placebo.The dual therapy(NAC+DEXA)group received intravenous administration of 10 mg DEXA every 12 h,NAC 24 h prior to cTACE(150 mg/kg/h for 1 h followed by 12.5 mg/kg/h for 4 h),and a continuous infusion of 6.25 mg/h NAC plus 4 mg DEXA every 12 h for 48 h after cTACE.The placebo group received an infusion of 5%glucose solution until 48 h after procedure.PES was defined by South West Oncology Group toxicity code grading of more than 2 that was calculated using incidence of fever,nausea,vomiting,and pain.RESULTS One-hundred patients were enrolled with 50 patients in each group.Incidence of PES was significantly lower in the NAC+DEXA group compared with in the placebo group(6%vs 80%;P<0.001).Multivariate analysis showed that the dual treatment is a protective strategic therapy against PES development[odds ratio(OR)=0.04;95%confidence interval(CI):0.01-0.20;P<0.001).Seven(14%)patients in the placebo group,but none in the NAC+DEXA group,developed post-TACE liver decompensation.A dynamic change in Albumin-Bilirubin score of more than 0.5 point was found to be a risk factor for post-TACE liver decompensation(OR=42.77;95%CI:1.01-1810;P=0.049).CONCLUSION Intravenous NAC+DEXA administration ameliorated the occurrence of PES event after cTACE in patients with intermediate-stage HCC.展开更多
基金Supported by Faculty of Medicine Vajira Hospital,Navamindradhiraj University Research Fund,No.1-67.
文摘BACKGROUND Hepatocellular carcinoma(HCC)is a major health concern in Thailand,with most patients diagnosed at the intermediate stage.Transarterial chemoembolization(TACE)is the standard treatment;however,postembolization syndrome(PES)remains a common complication.Although both dexamethasone(DEXA)and N-acetylcysteine(NAC)have shown efficacy in reducing PES,no study has directly compared their effects.AIM To compare the incidence of PES between DEXA and NAC in intermediate-stage HCC patients undergoing conventional TACE(cTACE).METHODS A randomized,double-blind,controlled trial was conducted at two tertiary hospitals in Thailand from November 2024 to April 2025.Eligible HCC patients(aged 18-70 years)were randomized(1:1)to receive either NAC(150 mg/kg/hour loading dose,followed by 50 mg/kg over 4 hours,then 6.25 mg/kg/hour for 48 hours post-cTACE)or DEXA(8 mg IV 1 hour before cTACE).cTACE was performed by blinded interventional radiologists.The primary outcome was PES occurrence within 48 hours,assessed using South West Oncology Group toxicity coding and the Common Terminology Criteria for Adverse Events.The secondary outcomes were post-cTACE liver decompensation and the dynamic changes in the albumin-bilirubin(ALBI)score.RESULTS A total of 56 intermediate-stage HCC patients were included(DEXA,n=28;NAC,n=28).Most had preserved liver function,with 92.9%classified as Child-Pugh A.The maximum tumor size was 6.2 cm,and 85.7%had multiple lesions.Additionally,39 patients(69.6%)met the beyond up-to-7 criteria.Overall,27 patients(48.2%)developed PES.After adjusting for confounding factors,the NAC group had a significantly lower incidence of PES than the DEXA group(32.1%vs 64.3%;adjusted odds ratio=0.17,95%confidence interval:0.03-0.87,P=0.033).Only two patients(3.6%)developed post-cTACE liver decompensation.Furthermore,51.8%patients experienced worsening ALBI scores within 48 hours post-procedure;however,the rate of ALBI score worsening did not significantly differ between the groups.CONCLUSION Compared with DEXA,NAC significantly reduces the incidence of PES,regardless of its impact on liver function recovery.Therefore,NAC is a preferable option for reducing PES in Barcelona Clinic Liver Cancer-B stage HCC patients with preserved liver function.
基金the Navamindradhiraj University Research Fund and the Faculty of Medicine Vajira Hospital,Navamindradhiraj University,93/2564.
文摘BACKGROUND Conventional transarterial chemoembolization(cTACE)is the current standard treatment for intermediate-stage hepatocellular carcinoma(HCC).Postembolization syndrome(PES)is complex clinical syndrome that presents as fever,abdominal pain,nausea,and vomiting.Either dexamethasone(DEXA)or Nacetylcysteine(NAC)is used to prevent PES;however,the synergistic effect of their combined therapy for preventing PES and liver decompensation has not been determined.AIM To evaluate the efficacy of DEXA and NAC combination in preventing PES and liver decompensation after cTACE.METHODS Patients with Barcelona Clinic Liver Cancer stage A or B HCC who were scheduled for TACE were prospectively enrolled.All patients were randomly stratified to receive NAC and DEXA or placebo.The dual therapy(NAC+DEXA)group received intravenous administration of 10 mg DEXA every 12 h,NAC 24 h prior to cTACE(150 mg/kg/h for 1 h followed by 12.5 mg/kg/h for 4 h),and a continuous infusion of 6.25 mg/h NAC plus 4 mg DEXA every 12 h for 48 h after cTACE.The placebo group received an infusion of 5%glucose solution until 48 h after procedure.PES was defined by South West Oncology Group toxicity code grading of more than 2 that was calculated using incidence of fever,nausea,vomiting,and pain.RESULTS One-hundred patients were enrolled with 50 patients in each group.Incidence of PES was significantly lower in the NAC+DEXA group compared with in the placebo group(6%vs 80%;P<0.001).Multivariate analysis showed that the dual treatment is a protective strategic therapy against PES development[odds ratio(OR)=0.04;95%confidence interval(CI):0.01-0.20;P<0.001).Seven(14%)patients in the placebo group,but none in the NAC+DEXA group,developed post-TACE liver decompensation.A dynamic change in Albumin-Bilirubin score of more than 0.5 point was found to be a risk factor for post-TACE liver decompensation(OR=42.77;95%CI:1.01-1810;P=0.049).CONCLUSION Intravenous NAC+DEXA administration ameliorated the occurrence of PES event after cTACE in patients with intermediate-stage HCC.
