Neutrophil/Lymphocyte Ratio Predicts Increased Risk of Immediate Progressive Disease following Chemoembolization of Hepatocellular Carcinoma.

PURPOSE: To demonstrate that patients with hepatocellular carcinoma (HCC) and elevated baseline neutrophil/lymphocyte ratio (NLR) have a significantly greater risk of progressive disease following initial transarterial chemoembolization. MATERIALS AND METHODS: A total of 190 HCC patients (149 male/41 female) treated with transarterial chemoembolization between July 2013 and July 2017 were reviewed. Mean patient age was 62. Child-Pugh grades were 132 A, 61 B, and 4 C. Tracked criteria included etiology of cirrhosis, tumor number, Barcelona Clinic Liver Cancer score, diameter of the largest 2 tumors, and presence of portal vein thrombosis. Complete blood count with differential before the procedure was used for NLR calculation. Follow-up imaging was performed 2 months after treatment. The modified response evaluation criteria in solid tumors were used to assess response. The association between baseline NLR and tumor response (ordinal modified response evaluation criteria in solid tumors categories) on 2-month follow-up imaging was evaluated using the proportional odds logistic regression model. RESULTS: A total of 194 patients (76.6%) patients had a preprocedural NLR <3.5, and 59 (23%) patients had a preprocedural NLR ≥3.5. There was a statistically significant association between baseline NLR and immediate progression on 2-month follow-up imaging (mean NLR 4.10, 2.76, 2.72, and 2.48 for progressive and stable disease and partial and complete response, respectively; odds ratio 2.1, P = .04). NLR (P = .021) and tumor multiplicity (P = .011) predicted progressive disease at 2-month imaging. CONCLUSIONS: Elevated baseline NLR is associated with higher rates of HCC tumor progression at 2-month follow-up imaging after transarterial chemoembolization.

Outpatient Transarterial Chemoembolization of Hepatocellular Carcinoma: Review of a Same-Day Discharge Strategy.

PURPOSE: To test the hypothesis that same-day discharge of selected transarterial chemoembolization patients would not increase 30-day readmission rate compared with overnight observation. MATERIALS AND METHODS: With institutional review board approval, 193 hepatocellular carcinoma patients who underwent transarterial chemoembolization from July 2013 to June 2016 were reviewed. Treatment was conventional/lipiodol transarterial chemoembolization with 50 mg doxorubicin/10 mg mitomycin-c/particles or drug-eluting embolics transarterial chemoembolization with 50-75 mg doxorubicin/vial. At 3 hours, patients tolerating oral intake and not requiring intravenous analgesics were considered for discharge. The primary outcome measure was 30-day readmission for observation versus discharge using chi-squared (χ2) analysis. The secondary aim was to identify baseline or treatment variables independently associated with readmission, including Child-Pugh class, medically managed encephalopathy or ascites, patient age (<65 vs ≥65), tumor number (1 or >1), and level of embolization (segmental vs lobar). RESULTS: Patients underwent 261 transarterial chemoembolization procedures. The 30-day readmission rate was not significantly different between observed patients (n = 179, 9.0%) and discharged patients (n = 82, 13.8%; P = .33). Readmission was not related to the selected agent (conventional/lipiodol-transarterial chemoembolization, 11.0% vs drug-eluting embolics transarterial chemoembolization, 7.5%; P = .36). Baseline variables associated with readmission were Child-Pugh B/C (χ2 = 7.9, P < .01), history of encephalopathy (χ2 = 15.4, P < 0.01), and ascites (χ2 = 4.4, P < .05). Patient age (<65 vs ≥65), tumor number (1 vs >1), and level of embolization (segmental vs lobar) were not predictive of readmission (all P > .05). CONCLUSIONS: Same-day discharge after transarterial chemoembolization does not increase the risk of 30-day readmission. Child-Pugh B/C patients, as well as those with ascites or encephalopathy, have the highest risk of readmission.

Are prophylactic antibiotics necessary prior to transarterial chemoembolization for hepatocellular carcinoma in patients with native biliary anatomy?

BACKGROUND AND OBJECTIVES: Prophylactic antibiotics are frequently administered for transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC). In patients without previous biliary instrumentation, infection risk from TACE is low. We hypothesized that there is a negligible rate of infection in these patients without prophylactic antibiotics. METHODS: We reviewed consecutive patients undergoing TACE between 7/1/2013-6/15/2016. All patients had an intact Sphincter of Oddi, received no peri-procedural antibiotics, and had 30+ days follow-up. Level of arterial selection was recorded. Baseline Child-Pugh (CP) and Barcelona Clinic Liver Cancer (BCLC) scores were recorded. The primary outcome measure was the absence of clinical or imaging findings of hepatic abscess within 30 days. RESULTS: A total of 171 patients underwent 235 TACE procedures. CP scores were A (n = 109), B (n = 47), and C (n = 15). BCLC scores were 0 (n = 1), A (n = 108), B (n = 47), and C (n = 15). TACE was performed segmentally (n = 208) or lobar (n = 27). Three patients died of non-infectious causes before 30 days. No hepatic abscesses developed in evaluable patients: 0/232 infusions. CONCLUSIONS: In patients with HCC and an intact Sphincter of Oddi, TACE was performed safely without prophylactic antibiotics. The majority of the patients were BCLC and CP A/B. Additional study of BCLC and CP C patients is warranted.