Naslov (srp)

Uticaj COVID-19 pandemije na ishod transarterijske hemoembolizacije kod pacijenata sa hepatocelularnim karcinomom : doktorska disertacija

Autor

Filipović, Aleksandar, 1981-

Doprinosi

Galun, Danijel, 1974-
Stević, Ruža, 1968-
Mašulović, Dragan, 1961-
Till, Viktor, 1964-
Sagić, Dragan, 1958-

Opis (eng)

Introduction: The reduced therapeutic options for the treatment of patients with hepatocellularcarcinoma due to the pandemic, and at the same time the necessity of reducing the risk of infectionwith the SARS-CoV-2 virus, a certain updates on the treatment standards have been proposed. Duringthe early phase of the pandemic, bearing in mind the limited medical resources for providing healthcare to non-covid patients, a consensus was reached that the number of elective surgeries should bereduced and that patients with hepatocellular carcinoma should be treated using locoregionaltherapy. Transarterial chemoembolization (TACE) is the most commonly used method oflocoregional treatment of patients with hepatocellular carcinoma. One of the reasons for using thismethod is that it can be used as a "bridging therapy" for patients who are candidates for surgicaltreatment, while patients are exposed to a lower risk of COVID-19 infection in healthcare facilities. Insome cases, TACE is the definitive treatment.Objective: The main objective of this study was to determine the impact of the COVID-19 pandemicon the outcome of transarterial chemoembolization in patients with hepatocellular carcinoma, in orderto 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 withhepatocellular carcinoma hospitalized in the Clinic for Digestive Surgery of the University ClinicalCentre of Serbia, who underwent conventional transarterial chemoembolization in the Department ofInterventional Radiology of the Center for Radiology, from September 2018 to December 2021, wereincluded. Depending on the time when the TACE procedure was performed, the patients were dividedinto two groups: the study group consisted of patients treated during the pandemic, while the controlgroup consisted of patients treated before the pandemic. Both groups were analyzed for inter- andintragroup variability, technical success, complications and length of survival. Data on patientstreated before the pandemic were continuously prospectively collected in the database of patientstreated with the TACE procedure in the Clinic for Digestive Surgery of the University Clinical Centreof Serbia (Department of Hepato-Bilio-Pancreatic Surgery).Results: During the pandemic, the waiting time of patients for the TACE procedure was significantlylonger compared to the waiting time before the pandemic (p<0.001). There is no statisticallysignificant difference in the demographic characteristics between the groups, as well as in terms ofclinical-pathological and laboratory analyses. The median follow-up was 14 months, and in thatinterval 65% of patients were alive. Statistical analysis of the length of survival did not reveal asignificant difference between the groups (p=0.823). Cox's regression analysis showed in the modelthat an increase in MELD is a risk factor for a fatal outcome, which was also confirmed bymultivariate analysis.Conclusions: The results of this study indicate that the COVID-19 pandemic had no impact on thefinal outcome of TACE procedures applied in the treatment of patients with hepatocellularcarcinoma. There was no statistically significant difference in the survival of patients treated in thepre-pandemic period compared to patients treated during the COVID-19 pandemic. MELD score isproven 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, itis rational to direct interventional radiological resources towards the treatment of those patients inwhom there is a higher probability of a good therapeutic outcome.

Opis (srp)

Uvod: Zbog pandemijom redukovanih terapijskih opcija za lečenje bolesnika sa hepatocelularnimkarcinomom, 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 uvidu ograničene medicinske resurse za pružanje zdravstvene zaštite nekovid bolesnicima, postignutje konsenzus da treba redukovati broj elektivnih operacija te da bolesnike sa hepatocelularnimkarcinomom treba lečiti primenom lokoregionalne terapije. Transarterijska hemoembolizacija(TACE) je najčešće korišćena metoda lokoregionalnog tretmana bolesnika sa hepatocelularnimkarcinomom. Jedan od razloga za primenu ove metode je to što se ona može koristiti i kao „bridžingterapija“ za bolesnike koji su kandidati za operativni tretman, a da su pri tom bolesnici izloženimanjem riziku od COVID-19 infekcije u zdravstvenim ustanovama. U pojedinim slučajevima TACEje i definitivni tretman.Cilj rada: Cilj ovog istraživanja bio je da se utvrdi uticaj COVID-19 pandemije na ishodtransarterijskih hemoembolizacija kod bolesnika sa hepatocelularnim karcinomom, kako bi sevalidirale aktuelne preporuke za bezbednu primenu TACE procedure tokom COVID-19 pandemije.Metod: U ovu retrospektivno/prospektivnu kohortnu studiju uključeno je 97 bolesnika sahepatocelularnim karcinomom hospitalizovanih u Klinici za digestivnu hirurgiju Univerzitetskogkliničkog centra Srbije kod kojih je u Odseku interventne radiologije Centra za Radiologiju, počevod septembra meseca 2018. godine do decembra 2021. godine učinjena konvencionalnatransarterijska 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 prepandemije. Obe grupe su analizirane na inter i intragrupnu varijabilnost, tehnički uspeh, komplikacijei dužinu preživljavanja. Podaci o bolesnicima lečenim pre pandemije su kontinuirano prospektivnoprikupljani te je formirana baza podataka bolesnika lečenih TACE procedurom u Klinici zadigestivnu hirurgiju Univerzitetskog kliničkog centra Srbije (Odeljenje za hepato-bilio-pankreasnuhirurgiju).Rezultati rada: Tokom pandemije vreme čekanja bolesnika na TACE proceduru bilo je značajnoduže u odnosu na vreme čekanja pre pandemije (p<0.001). Nema statistički značajne razlike udemografskim karakteristikama između grupa, kao ni u pogledu kliničko-patoloških i laboratorijskihanaliza. 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 ishodšto je potvrđeno i multivarijantnom analizom.Zaključak: Rezultati ove studije ukazuju da COVID-19 pandemija nije imala uticaj na krajnji ishodTACE procedura primenjenih u lečenju bolesnika sa hepatocelularnim karcinomom. Nije bilostatistički značajne razlike u preživljavanju bolesnika lečenih u prepandemijskom periodu u odnosuna bolesnike lečene tokom COVID-19 pandemije. MELD skor je prediktivni faktor mortaliteta kodbolesnika sa HCC-om. U uslovima pandemije, kada je pružanje zdravstvene zaštite nekovidbolesnicima organičeno, racionalno je usmeriti interventno radiološke resurse ka lečenju onihbolesnika kod kojih postoji veća verovatnoća za dobar terapijski ishod.

Opis (srp)

Medicina - Radiologija i nuklearna medicina / Medicine - Radiology and nuclear medicine Datum odbrane: 22.12.2023.

Jezik

srpski

Datum

2023

Licenca

Ovo delo je licencirano pod uslovima licence
Creative Commons CC BY-NC-ND 3.0 AT - Creative Commons Autorstvo - Nekomercijalno - Bez prerada 3.0 Austria License.

http://creativecommons.org/licenses/by-nc-nd/3.0/at/legalcode

Predmet

OSNO - Opšta sistematizacija naučnih oblasti, Biomedicinska tehnika. Nuklearna medicina

COVID-19, transarterijska hemoembolizacija, lokoregionalna terapija, hepatocelularni karcinom

616.36-006.6:615.849(043.3)

OSNO - Opšta sistematizacija naučnih oblasti, Biomedicinska tehnika. Nuklearna medicina

COVID-19, transarterial chemoembolization, locoregional therapy, hepatocellular carcinoma