Uticaj COVID-19 pandemije na ishod transarterijske hemoembolizacije kod pacijenata sa hepatocelularnim karcinomom
Impact of COVID-19 pandemic on the outcomes of transarterial chemoembolization in patients with hepatocellular carcinoma
Докторанд
Filipović, AleksandarМентор
Mašulović, DraganЧланови комисије
Galun, DanijelSagić, Dragan
Stević, Ruža
Till, Viktor
Метаподаци
Приказ свих података о дисертацијиСажетак
Uvod: Zbog pandemijom redukovanih terapijskih opcija za lečenje bolesnika sa hepatocelularnim
karcinomom, a ujedno i neophodnosti smanjenja rizika od zaražavanja SARS-CoV-2 virusom,
predložena su određena odstupanja od standarda u lečenju. Tokom rane faze pandemije, imajući u
vidu ograničene medicinske resurse za pružanje zdravstvene zaštite nekovid bolesnicima, postignut
je konsenzus da treba redukovati broj elektivnih operacija te da bolesnike sa hepatocelularnim
karcinomom treba lečiti primenom lokoregionalne terapije. Transarterijska hemoembolizacija
(TACE) je najčešće korišćena metoda lokoregionalnog tretmana bolesnika sa hepatocelularnim
karcinomom. Jedan od razloga za primenu ove metode je to što se ona može koristiti i kao „bridžing
terapija“ za bolesnike koji su kandidati za operativni tretman, a da su pri tom bolesnici izloženi
manjem riziku od COVID-19 infekcije u zdravstvenim ustanovama. U pojedinim slučajevima TACE
je i definitivni tretman.
Cilj rada: Cilj ovog istraživanj...a bio je da se utvrdi uticaj COVID-19 pandemije na ishod
transarterijskih hemoembolizacija kod bolesnika sa hepatocelularnim karcinomom, kako bi se
validirale aktuelne preporuke za bezbednu primenu TACE procedure tokom COVID-19 pandemije.
Metod: U ovu retrospektivno/prospektivnu kohortnu studiju uključeno je 97 bolesnika sa
hepatocelularnim karcinomom hospitalizovanih u Klinici za digestivnu hirurgiju Univerzitetskog
kliničkog centra Srbije kod kojih je u Odseku interventne radiologije Centra za Radiologiju, počev
od septembra meseca 2018. godine do decembra 2021. godine učinjena konvencionalna
transarterijska hemoembolizacija.
U zavisnosti od vremena kada je učinjena TACE procedura bolesnici su podeljeni u dve grupe:
studijsku grupu čine bolesnici lečeni tokom pandemije dok su u kontrolnoj grupi bolesnici lečeni pre
pandemije. Obe grupe su analizirane na inter i intragrupnu varijabilnost, tehnički uspeh, komplikacije
i dužinu preživljavanja. Podaci o bolesnicima lečenim pre pandemije su kontinuirano prospektivno
prikupljani te je formirana baza podataka bolesnika lečenih TACE procedurom u Klinici za
digestivnu hirurgiju Univerzitetskog kliničkog centra Srbije (Odeljenje za hepato-bilio-pankreasnu
hirurgiju).
Rezultati rada: Tokom pandemije vreme čekanja bolesnika na TACE proceduru bilo je značajno
duže u odnosu na vreme čekanja pre pandemije (p<0.001). Nema statistički značajne razlike u
demografskim karakteristikama između grupa, kao ni u pogledu kliničko-patoloških i laboratorijskih
analiza. Mediana praćenja iznosila je 14 meseci, a u tom intervalu 65% bolesnika je bilo živo.
Statističkom analizom dužine preživljavanja nije uočena značajna razlika među grupama (p=0.823).
Cox-ova regresiona analiza je pokazala u modelu da je povećanje MELD faktor rizika za fatalni ishod
što je potvrđeno i multivarijantnom analizom.
Zaključak: Rezultati ove studije ukazuju da COVID-19 pandemija nije imala uticaj na krajnji ishod
TACE procedura primenjenih u lečenju bolesnika sa hepatocelularnim karcinomom. Nije bilo
statistički značajne razlike u preživljavanju bolesnika lečenih u prepandemijskom periodu u odnosu
na bolesnike lečene tokom COVID-19 pandemije. MELD skor je prediktivni faktor mortaliteta kod
bolesnika sa HCC-om. U uslovima pandemije, kada je pružanje zdravstvene zaštite nekovid
bolesnicima organičeno, racionalno je usmeriti interventno radiološke resurse ka lečenju onih
bolesnika kod kojih postoji veća verovatnoća za dobar terapijski ishod.
Introduction: The reduced therapeutic options for the treatment of patients with hepatocellular
carcinoma due to the pandemic, and at the same time the necessity of reducing the risk of infection
with the SARS-CoV-2 virus, a certain updates on the treatment standards have been proposed. During
the early phase of the pandemic, bearing in mind the limited medical resources for providing health
care to non-covid patients, a consensus was reached that the number of elective surgeries should be
reduced and that patients with hepatocellular carcinoma should be treated using locoregional
therapy. Transarterial chemoembolization (TACE) is the most commonly used method of
locoregional treatment of patients with hepatocellular carcinoma. One of the reasons for using this
method is that it can be used as a "bridging therapy" for patients who are candidates for surgical
treatment, while patients are exposed to a lower risk of COVID-19 infection in healthcare facilities. In
some cases, TACE is the ...definitive treatment.
Objective: The main objective of this study was to determine the impact of the COVID-19 pandemic
on the outcome of transarterial chemoembolization in patients with hepatocellular carcinoma, in order
to validate the current recommendations for the safe use of the TACE procedure during the COVID-
19 pandemic.
Materials and methods: In this retrospective/prospective cohort study, 97 patients with
hepatocellular carcinoma hospitalized in the Clinic for Digestive Surgery of the University Clinical
Centre of Serbia, who underwent conventional transarterial chemoembolization in the Department of
Interventional Radiology of the Center for Radiology, from September 2018 to December 2021, were
included. Depending on the time when the TACE procedure was performed, the patients were divided
into two groups: the study group consisted of patients treated during the pandemic, while the control
group consisted of patients treated before the pandemic. Both groups were analyzed for inter- and
intragroup variability, technical success, complications and length of survival. Data on patients
treated before the pandemic were continuously prospectively collected in the database of patients
treated with the TACE procedure in the Clinic for Digestive Surgery of the University Clinical Centre
of Serbia (Department of Hepato-Bilio-Pancreatic Surgery).
Results: During the pandemic, the waiting time of patients for the TACE procedure was significantly
longer compared to the waiting time before the pandemic (p<0.001). There is no statistically
significant difference in the demographic characteristics between the groups, as well as in terms of
clinical-pathological and laboratory analyses. The median follow-up was 14 months, and in that
interval 65% of patients were alive. Statistical analysis of the length of survival did not reveal a
significant difference between the groups (p=0.823). Cox's regression analysis showed in the model
that an increase in MELD is a risk factor for a fatal outcome, which was also confirmed by
multivariate analysis.
Conclusions: The results of this study indicate that the COVID-19 pandemic had no impact on the
final outcome of TACE procedures applied in the treatment of patients with hepatocellular
carcinoma. There was no statistically significant difference in the survival of patients treated in the
pre-pandemic period compared to patients treated during the COVID-19 pandemic. MELD score is
proven to be a predictive factor of mortality in patients with HCC.
In the conditions of a pandemic, when the provision of health care to non-covid patients is limited, it
is rational to direct interventional radiological resources towards the treatment of those patients in
whom there is a higher probability of a good therapeutic outcome.