Impact of COVID-19 Pandemic on Intervals and Outcomes of Repeated Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma

Abstract

PurposeGiven that the novel coronavirus disease (COVID-19) pandemic has disrupted operations globally, an institution’s ability to repeat transarterial chemoembolization (TACE) for patients with hepatocellular carcinoma (HCC) has also been affected. The aim of this study was to evaluate the impact of the COVID-19 on the intervals and outcomes of TACE in HCC patients.Materials and MethodsThis retrospective study included 154 HCC patients who underwent follow-up after TACE treatment from January 2020 to March 2020 (n = 71, study group) and January 2019 to March 2019 (n = 83, control group) at two institutions in China. The endpoints included the follow-up interval and overall response rate (ORR). Multivariate logistic regression analyses were performed to identify independent risk factors for a worse ORR. The cut-off point was determined to divide follow-up durations into long- and short-intervals.ResultsThe median follow-up interval was 82.0 days (IQR, 61–109) in the study group, which was significantly longer than 66.0 days (IQR, 51–94) in the control group (P = 0.004). The ORR was 23.9 and 39.8% in the study and control group, respectively (P = 0.037). The cut-off value was 95 days. The grouping (OR, 2.402; 95% CI, 1.040–5.546; P = 0.040), long interval (OR, 2.573; 95% CI, 1.022–6.478; P = 0.045), and China liver cancer staging system (OR, 2.500; 95% CI, 1.797–3.480; P <0.001) were independent predictors for the efficacy of TACE treatment.ConclusionsThe COVID-19 pandemic causes a longer follow-up interval in general, which may further lead to a lower ORR in HCC patients. Those with a follow-up interval of >95 days tend to have a worse prognosis.

COVID-19-associated liver injury: Clinical characteristics, pathophysiological mechanisms and treatment management

“…In a large study of liver cancer patients infected with SARS-CoV-2, 52 patients died within 30 days of infection, and 43 (82.7%) of these deaths were related to SARS-CoV-2 infection [127] . In a follow-up study of patients with HCC, the COVID-19 pandemic led to a longer follow-up interval for patients, which may reduce the overall response rate of patients, and the prognosis of patients was worse when the follow-up interval was >95 days [129] . This should remind liver cancer patients, especially those with early-stage liver cancer, of the importance of timely follow-up examinations and not to delay testing due to the risk of SARS-CoV-2 infection, which can lead to a large tumor outbreak.…”

Coronavirus Disease 2019 Vaccinations in Patients With Chronic Liver Disease and Liver Transplant Recipients: An Update

“…Several studies have compared the management of HCC between 2020 and the same period in 2019 and reported a significant reduction in HCC surveillance completion rates and the number of new HCC cases ( 35 , 36 ). In patients already diagnosed with HCC, delayed treatment rates were significantly higher and the overall response rate based on post-treatment imaging was lower in 2020 than in 2019 ( 34 , 37 ).…”

Screening, Surveillance, and Management of Hepatocellular Carcinoma During the COVID-19 Pandemic: a Narrative Review

“…Diagnosis of new cases HCC was noticed to drastically reduce during the COVID-19 pandemic [ 6 , 8 , 11 – 13 ]. This was attributed to the global mandates of lockdowns and the reduction of elective services in the healthcare community which resulted in the following [ 6 , 8 , 11 – 14 , 35 , 39 , 40 ]: Delay consultations of patients their general practitioner Decreased referral by other professionals because of fear of COVID-19 infection Reduced access to diagnostic tools, operating theaters, and intensive care unit (ICU) Travel limitation which prevented patients from other areas reaching medical centers …”

“…Curative ablation should not be delayed. In patients with three or fewer tumors, each smaller than 30 mm, and of Child–Pugh class A or B, ablation can be used instead of resection [ 5 , 15 , 19 , 21 , 24 , 27 – 29 , 39 ].…”

“…However, some studies have propose that neoadjuvant therapies can also be used to bridge patients while they wait for surgery, reserving resection for the time of progression or after the pandemic [ 5 , 15 , 19 , 21 , 24 , 27 – 29 , 39 ]. For patients on the transplant list, local ablative and regional therapies, such as transarterial chemoembolization (TACE), or transarterial radioembolization (TARE), can be more frequently used to bridge patients to ensure disease control while waiting for the transplant [ 16 , 21 , 28 ].…”