• hepatocellular carcinoma
• intra-arterial lidocaine administration
• long-term survival
• propensity score matching
• transcatheter arterial chemoembolisation

• Humans
• Carcinoma, Hepatocellular/therapy
• Carcinoma, Hepatocellular/mortality
• Lidocaine/administration & dosage
• Lidocaine/therapeutic use
• Liver Neoplasms/therapy
• Liver Neoplasms/mortality
• Female
• Retrospective Studies
• Male
• Propensity Score
• Chemoembolization, Therapeutic/methods
• Middle Aged
• Aged
• Anesthetics, Local/administration & dosage
• Anesthetics, Local/therapeutic use
• Treatment Outcome

• Humans
• Carcinoma, Hepatocellular/surgery
• Carcinoma, Hepatocellular/therapy
• Carcinoma, Hepatocellular/diagnosis
• Liver Neoplasms/surgery
• Liver Neoplasms/therapy
• Liver Neoplasms/diagnosis
• Anesthesia/methods
• Anesthesia/trends
• Critical Care/methods
• Critical Care/trends
• Anesthesiologists/trends
• Liver Transplantation/methods
• Hepatectomy/methods

• abdominal pain
• hepatic arterial infusion chemotherapy
• hepatocellular carcinoma
• risk factors

• Bariatric medicine
• Embolization, Therapeutic
• Obesity
• Weight loss

• Humans
• Embolization, Therapeutic/methods
• Female
• Retrospective Studies
• Male
• Middle Aged
• Gastric Artery
• Adult
• Aged
• Obesity/therapy
• Obesity/complications
• Treatment Outcome
• Weight Loss
• Microspheres

• Network analysis
• Primary liver cancer
• Symptom management
• Transcatheter arterial chemoembolization

• liver cancer
• pain

• Humans
• Carcinoma, Hepatocellular/complications
• Carcinoma, Hepatocellular/therapy
• Carcinoma, Hepatocellular/pathology
• Liver Neoplasms/complications
• Liver Neoplasms/therapy
• Liver Neoplasms/pathology
• Nomograms
• Retrospective Studies
• Chemoembolization, Therapeutic/adverse effects
• Abdominal Pain/etiology

• 2022JJA140009 Natural Science Foundation of Guangxi Zhuang Autonomous Region
• S2022132 Guangxi medical and healthcare appropriate technology development and promotion and application projects
• Z-C20230840 Self-financed scientific research projects of Guangxi Autonomous Region Health and Wellness Commission

• Liver cancer
• Pain
• Postembolization syndrome
• Predictive model
• Transarterial chemoembolization

Pain after transcatheter arterial chemoembolisation (TACE) can seriously affect the prognosis of patients and the insertion of additional medical resources.

To develop an early warning model for predicting pain after TACE to enable the implementation of preventive analgesic measures.

We retrospectively collected the clinical data of 857 patients (from January 2016 to January 2020) and prospectively enrolled 368 patients (from February 2020 to October 2022; as verification cohort) with hepatocellular carcinoma (HCC) who received TACE in the Hepatic Surgery Center of Tongji Hospital. Five predictive models were established using machine learning algorithms, namely, random forest model (RFM), support vector machine model, artificial neural network model, naive Bayes model and decision tree model. The efficacy of these models in predicting postoperative pain was evaluated through receiver operating characteristic curve analysis, decision curve analysis and clinical impact curve analysis.

A total of 24 candidate variables were included in the predictive models using the iterative algorithms. Age, preoperative pain, number of embolised tumours, distance from the liver capsule, dosage of iodised oil and preoperative prothrombin activity were closely associated with postoperative pain. The accuracy of the predictive model was compared between the training [area under the curve (AUC) = 0.798; 95% confidence interval (CI): 0.745-0.851] and verification (AUC = 0.871; 95%CI: 0.818-0.924) cohorts, with RFM having the best predictive efficiency (training cohort: AUC = 0.869, 95%CI: 0.816-0.922; internal verification cohort: AUC = 0.871; 95%CI: 0.818-0.924).

The five predictive models based on advanced machine learning algorithms, especially RFM, can accurately predict the risk of pain after TACE in patients with HCC. RFM can be used to assess the risk of pain for facilitating preventive treatment and improving the prognosis.

• Hepatocellular carcinoma
• Transcatheter arterial chemoembolization
• Pain
• Machine learning algorithm
• Prediction

• Analgesics opioid
• Chemoembolization
• Hepatocellular carcinoma
• Liver cirrhosis
• Non-narcotic analgesics
• Pain measurement

• Male
• Humans
• Female
• Middle Aged
• Aged
• Aged, 80 and over
• Carcinoma, Hepatocellular/therapy
• Carcinoma, Hepatocellular/pathology
• Liver Neoplasms/therapy
• Liver Neoplasms/pathology
• Anesthesia, Local
• Chemoembolization, Therapeutic/methods
• Abdominal Pain/etiology
• Analgesia
• Treatment Outcome
• Retrospective Studies

Background: Interest has revived in the use of hepatic arterial infusion chemotherapy (HAIC) for intermediate-advanced hepatocellular carcinoma (HCC) while transarterial chemoembolization (TACE) has been a longstanding loco-regional therapy.

Aim: We conducted a systematic review and meta-analysis of patients with unresectable HCC treated with HAIC or TACE to look for differences in survival, adverse events, mortality and downstaging.

Methods: All studies published before 29 July 2022 were identified by searching PubMed, Embase, Web of Science and Cochrane Library databases for patients with unresectable HCC and received HAIC or TACE as initial treatment. Data extracted from studies was statistically analysed using RevMan5.3 software.

Results: A total of one randomized controlled trial (RCT) and 7 cohort studies (5 retrospective, 2 prospective) including 1,060 (TACE group: 534, HAIC group: 526) patients were screened. Compared with the TACE group, patients who received HAIC as initial therapy had better overall survival (OS) (HR = 0.53, 95%CI [0.40, 0.69]) and progression-free survival (PFS) (HR = 0.54, 95%CI [0.40, 0.72]). Further subgroup analysis revealed that HAIC showed priority over TACE on prognosis outcome regardless of tumour stage, especially in patients with advanced portal vein tumour thrombus (PVTT). Utilization of port system will not boost the efficacy of HAIC whereas using a replaced-microcatheter for each procedure could better reduce the progressive disease (PD) rate (RR = 0.55, 95%CI [0.40, 0.76]). The pooled RR favoured the HAIC group with regard to partial response (PR) (RR = 2.87, 95%CI [2.18, 3.78]) and this was validated by both GRADE summary and trial sequential analysis. The rate of resection after treatment was higher in the HAIC group (RR = 2.37, 95%CI [1.54, 3.66]), whilst no difference was found with procedure-related mortality (RR = 0.56, 95%CI [0.13, 2.38]) between two groups. Compared with the traditional chemotherapy regimen (fluorouracil/leucovorin/oxaliplatin) FOLFOX-HAIC appears to be better in improving the treatment efficacy.

Conclusion: Patients with unresectable HCC could potentially benefit more from HAIC rather than standard TACE treatment. A re-evaluation of HAIC as a treatment option in intermediate and advanced HCC is warranted.

This study is aimed at constructing and evaluating a prediction model of severe abdominal pain post-transcatheter arterial chemoembolization in patients with HBV-related primary liver cancer.

Patients with HBV-associated primary liver cancer who received transarterial chemoembolization (TACE) from March 2019 to March 2022 in the Interventional Therapy Department of our hospital were selected as the subjects, and the included 160 patients were randomly divided into modeling group (n = 120) and validation group (n = 40) in a ratio of 3 : 1. Visual analog scale (VAS) was used to assess pain severity. 120 patients in the modeling group were divided into no/mild abdominal pain group and severe abdominal pain group. The clinical data of the patients, including gender, age, TACE treatment history, vascular invasion, maximum diameter of tumor, infarction degree, preoperative Eastern Oncology Collaboration Group (ECOG) score, and Lipiodol dosage, were analyzed. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the prediction model for severe abdominal pain post-TACE.

A total of 116 patients (72.50%) had severe abdominal pain after TACE. Univariate analysis showed that severe abdominal pain after TACE in the modeling group was associated with TACE treatment history, maximum tumor diameter, infarction degree, and preoperative ECOG score (all P < 0.05), but not related to gender, age, vascular invasion, and Lipiodol dosage (all P > 0.05). Logistic regression analysis showed that TACE treatment history, maximum tumor diameter, infarction degree, and preoperative ECOG score were all independent influencing factors for acute abdominal pain post-TACE in HBV-HCC patients (all P < 0.05). The prediction model equation was Y = −3.673 + 1.722 × TACE treatment history + 1.175 × tumor maximum diameter + 2.064 × infarction degree + 1.555 × preoperative ECOG score. Goodness-of-fit test results showed no significant difference between the established prediction model and the observed value (χ² = 1.645, P = 0.560) and R² = 0.821, suggesting that the prediction ability of the model was relatively accurate. ROC analysis results showed that the area under the curve (AUC) of severe abdominal pain after TACE was 0.916 (0.862~0.970) and 0.902 (95% CI: 0.841~0.963) in the modeling group and the verification group, respectively.

TACE treatment history, tumor maximum diameter, infarction degree, and preoperative ECOG score are independent influencing factors for severe abdominal pain post-TACE in patients with HBV-HCC, and the prediction model established on this basis has good application value.