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| 1 | Trans-arterial chemo-embolization is safe and effective for very elderly patients with hepatocellular carcinoma显示文摘AIM: To assess the safety and efficacy of trans-arterial chemo-embolization (TACE) in very elderly patients. METHODS: A prospective cohort study, from 2001 to 2010, compared clinical outcomes following TACE between patients ≥ 75 years old and younger patients (aged between 65 and 75 years and younger than 65 years) with hepatocellular carcinoma (HCC), diagnosed according to the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases criteria. The decision that patients were not candidates for curative therapy was made by a multidisciplinary HCC team. Data collected included demographics, co-morbidities, liver disease etiology, liver disease severity and the number of procedures. The primary outcome was mortality; secondary outcomes included post-embolization syndrome (nausea, fever, abdominal right upper quadrant pain, increase in liver enzymes with no evidence of sepsis and with a clinical course limited to 3-4 d post procedure) and 30-d complications. Additionally, changes in liver enzyme measurements were assessed [alanine and aspartate aminotransferase (ALT and AST), gamma-glutamyl transpeptidase and alkaline phosphatase] in the week following TACE. Analysis employed both univariate and multivariate methods (Cox regression models). RESULTS: Of 102 patients who underwent TACE as sole treatment, 10 patients (9.8%) were > 80 years old at diagnosis; 13 (12.7%) were between 75 and 80 years, 45 (44.1%) were between 65 and 75 years and 34 (33.3%) were younger than 65 years. Survival analysis demonstrated similar survival patterns between the elderly patients and younger patients. Age was also not associated with the adverse event rate. Survival rates at 1, 2 and 3 years from diagnosis were 74%, 37% and 31% among patients < 65 years; 83%, 66% and 48% among patients aged 65 to 75 years; and 86%, 41% and 23% among patients ≥ 75 years. There were no differences between the age groups in the pre-procedural care, including preventive treatment for contrast nephropathy and prophylactic antibiotics. Multivariate survival analysis, controlling for disease stage at diagnosis with the Barcelona Clinic Liver Cancer score, number of TACE procedures, sex and alphafetoprotein level at the time of diagnosis, found no significant difference in the mortality hazard for elderly vs younger patients, and there were no differences in post-procedural complications. Serum creatinine levels did not change after 55% of the procedures, in all age groups. In 42% of all procedures, serum creatinine levels increased by no more than 25% above the baseline levels prior to TACE. Overall, there were 69 post-embolization events (23%). Hepatocellular enzymes often increased following TACE, with no association with prognosis. In 40% of the procedures, ALT and AST levels rose by at least 100%. The increases in hepatocellular enzymes occurred similarly in all age groups. CONCLUSION: TACE is safe and effective in very elderly patients with HCC, and is not associated with decreased survival or increased complication rates. | Matan J Cohen Allan I Bloom Orly Barak Alexander Klimov Tova Nesher Daniel Shouval Izhar Levi Oren Shibolet | 2013 | World Journal of Gastroenterology2013，19，16： | 13 |
| 2 | The increase of childhood chronic conditions in the united states显示文摘 | Perrin J M Bloom S R Gortmaker SL | 2007 | JA- MA2007，297，24： | 4 |
| 3 | HER-2/neu protein overexpression and gene amplification in human transitional cell carcinoma of the bladder显示文摘 | Christopher L Coogan Carlos R Estrada Shiv Kapur Kenneth J Bloom | 2004 | Urology2004，，4： | 2 |
| 4 | Rotation, scale and translation resilient watermarking for images显示文摘 | Lin C-Y Wu M Bloom J A | 2001 | IEEE Trans on Image Processing2001，10，5： | 1 |
| 5 | Environmental exposure to PBDEs and thyroid function among New York anglers 显示文摘 | Bloom M Sptiethoff H Vena J | 2008 | Environmental Toxicology and Pharmacology2008，25，3： | 1 |
| 6 | Haemodynamic responses to tracheal intubation following etomidate and fentang L for anaesthetic induction 显示文摘 | Leslie J Weiss bloom Davidl Reich | 1992 | Can J Anaesth1992，39，8： | 1 |
| 7 | A modular approach to key safeguarding 显示文摘 | ASMUTH C BLOOM J | 1983 | IEEE Transaction on Information Theory1983，29，2： | 1 |
| 8 | A human CXCL13-induced actin polymerization assay measured by fluorescence plate reader显示文摘 | Alley J Bloom L Kasaian M | | 0，，： | 1 |
| 9 | Rotation,scale and translation resilient watermarking for images显示文摘 | LIN C Y WU M BLOOM J A | 2001 | IEEE transactions on image processing2001，10，5： | 1 |
| 10 | Rotation,scale,and translation resilient watermarking for images显示文摘 | Lin C Y Wu M Bloom J A | 2001 | IEEE Transactions on Image Processing2001，10，5： | 1 |
| 11 | Cue-induced cowcaine craving: neuroanatomical specificity for drug users and drug stimuli显示文摘 | Garavan H Pankiewicz J Bloom A | 2000 | Am J Psychiatry2000，157，11： | 1 |
| 12 | Differential control of eosinophil survival by glucocorticoids显示文摘 | Bloom JW Chacko J Lohman IC | 2004 | Apoptosis2004，9，1： | 1 |
| 13 | Cue-induced cocaine craving:neuroanatomical specificity for drug users and drug stimuli显示文摘 | Garavan H Pankiewicz J Bloom A | 2000 | Am J Psychiatry2000，157，11： | 1 |
| 14 | Safety of desloratadine syrup in children 显示文摘 | Bloom M Staudlnger H Herron J | 2004 | Curr Med Res Opin2004，20，： | 1 |
| 15 | Improving growth of the very-low-birth-weight infants in the first 28-days 显示文摘 | Bloom BT Mulligan J Arnold C | 2003 | Pediatrics2003，112，11： | 1 |
| 16 | Genetic heteroge- neity in HER-2 testing in breast cancer: panel summary and guidelines 显示文摘 | Vance G H Barry T S Bloom K J | 2009 | Arch Pathol Lab Med2009，13，4： | 1 |
| 17 | Aleutian mink disease parvovirus infection of K562cells is antibody-dependent and is mediated via an Fc(gamma)RII receptor显示文摘 | Dworak L J Wolfinbarger J B Bloom M E | 1997 | Arch Virol1997，142，： | 1 |
| 18 | The Effect of Health on Economic Growth: A Production Function Approach显示文摘 | Bloom D E Canning D Sevilla J | 2004 | World Development2004，32，1： | 1 |
| 19 | Nuclear import and export signals in control of Nrf2显示文摘 | Jain AK Bloom DA J aiswal AK | 2005 | J Biol Chem2005，280，29： | 1 |
| 20 | Development of novel polymer/quasicrystal composite materials显示文摘 | Baikerikar K G Otaigbe J U | 2000 | Mater Sci Eng A2000，，： | 1 |
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