Nausea and Vomiting after Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma: Incidence and Risk Factor Analysis

Background: Nausea and vomiting after transcatheter arterial chemoembolization (TACE) for hepatocellularcarcinoma (HCC) are common in clinical practice, but few studies have reported the incidence and risk factorsof such events.
Objective: The purpose of this study was to analyze the incidence and risk factors of nausea andvomiting after TACE for HCC.
Methods: This study was a single-center retrospective analysis of a prospectivelymaintained database. Between May 2010 and October 2012, 150 patients with HCC were analyzed for incidenceand preprocedural risk factors.
Results: The incidence of postembolization nausea and vomiting was 38.8%and 20.9%, respectively, in patients with HCC. Patients who developed nausea had lower levels (<100 IU/L)of serum alkaline phosphatase (ALP) compared to those without nausea (123.04 ± 69.38 vs. 167.41 ± 138.95,respectively, p=0.044). Female gender correlated to a higher incidence of nausea as well (p=0.024). Patients whodeveloped vomiting, compared to those who did not, also had lower levels (<100 IU/L) of serum ALP (112.52 ±62.63 vs. 160.10 ± 127.80, respectively, p=0.010), and serum alanine transferase (ALT) (35.61 ± 22.87 vs. 44.97± 29.62, respectively, p=0.045). There were no statistical significances in the incidences of nausea and vomitingbetween male patients over 50 years old and female patients who have entered menopause (p=0.051 and p=0.409,respectively). Multivariate analysis by logistic regression analysis demonstrated that female gender and ALP>100IU/L were the most independent predictive factors of postembolization nausea (odds ratio (OR): 3.271, 95%CI: 1.176-9.103, p=0.023 and OR: 0.447, 95% CI: 0.216-0.927, p=0.030, respectively). ALP>100 IU/L was alsothe most independent predictive risk factor of postembolization vomiting (OR: 0.389, 95% CI: 0.159-0.952,p=0.039).
Conclusions: Postembolizaiton nausea and vomiting are common in patients with HCC. Recognitionof the risk factors presented above before TACE is important for early detection and proper management ofpostembolization nausea and vomiting. Nevertheless, future studies are required.