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

Background: Transarterial chemoembolization (TACE) may not be repeated “on-demand” timely for hepatocellular carcinoma (HCC) patients in the era of the novel coronavirus disease (COVID-19). We aim to evaluate the impact of the COVID-19 pandemic on the intervals and outcomes of TACE in HCC patients. Methods: This retrospective study included HCC patients who underwent TACE from Jan 1, 2020 to March 31, 2020 (study group) and Jan 1, 2019 to Mar 31, 2019 (control group) at two institutions in China. The endpoints included the TACE interval and the overall response rate (ORR). Uni- and multivariate logistic analyses were performed to identify independent risk factors associated with a worse ORR. The cut-off point was determined to divide repeated TACE time into long- and short- intervals. Findings: 154 patients (71 in the study group, 83 in the control group) were enrolled. The median TACE interval in the study group was 82·0 days (IQR, 61–109), longer than 66·0 days (IQR, 51–94) in the control group (p=0·004). The ORR was 23·9% in the study group, while 39·8% in the control group (p=0·037). The cut-off value was 95 days. The group (OR, 2·402; 95% CI, 1·040–5·546; p=0·040), the long interval (OR, 2·573; 95% CI, 1·022–6·478; p=0·045), and the stage system (OR, 2·500; 95% CI, 1·797–3·480; p<0·001) were independent predictors. Interpretation: For HCC patients, the COVID-19 pandemic results in a longer re-TACE schedule, which may further lead to a lower ORR. Patients with a TACE interval of more than 95 days may have a worse prognosis. Funding: This study was supported by the National Key Research and Development Project of China (2018YFA0704100), the National Natural Science Foundation of China (Major Scientific Research Instrument Development Program 81827805, 81441054, 81520108015, 81671796, 81901847), Jiangsu Provincial Medical Youth Talent Program (ZDRCA2016078), the Key Research and Development Project of Jiangsu Province (BE2019750), the Natural Science Foundation of Jiangsu Province (BK20190177), Innovation Platform of Jiangsu Provincial Medical Center (YXZXA2016005), and the Suzhou Science and Technology Youth Plan (KJXW2018003). Declaration of Interests: All authors declare no competing interests. Ethics Approval Statement: The study was approved by the institutional ethics review boards in two participating institutions and the requirement for written informed consent was waived due to its retrospective nature.