Determinants of Health-Related Quality of Life After Transarterial Chemoembolization in Hepatocellular Carcinoma Patients: A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategy
2.2. Inclusion and Exclusion Criteria
2.3. Study Selection
2.4. Data Extraction
2.5. Data Synthesis
2.6. Quality Assessment
3. Results
3.1. Characteristics of Studies
3.2. Quality Assessment of the Included Studies
3.3. HRQoL Assessment Tool and Time Point
3.4. Classification and Characteristics of HRQoL Assessment Tools
3.5. Influencing Factors on HRQoL of Studies Included
3.6. Categorization of Influencing Factors on HRQoL
4. Discussion
4.1. Demographic Factors
4.2. Clinical Factors
4.3. Psychological Factors
4.4. Social Support Factors
4.5. Physical Factors
4.6. Measurement Heterogeneity
4.7. Potential Impact of Evolving TACE Techniques on HRQoL Outcomes
4.8. Implications for Clinical Practice
4.9. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
HCC | Hepatocellular carcinoma |
TACE | Transarterial chemoembolization |
HRQoL | Health-related Quality of Life |
References
- Sung, H.; Ferlay, J.; Siegel, R.L.; Laversanne, M.; Soerjomataram, I.; Jemal, A.; Bray, F. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J. Clin. 2021, 71, 209–249. [Google Scholar] [CrossRef] [PubMed]
- Zhou, J.; Sun, H.; Wang, Z.; Cong, W.; Zeng, M.; Zhou, W.; Bie, P.; Liu, L.; Wen, T.; Kuang, M. Guidelines for the diagnosis and treatment of primary liver cancer (2022 edition). Liver Cancer 2023, 12, 405–444. [Google Scholar] [CrossRef] [PubMed]
- Brown, Z.J.; Tsilimigras, D.I.; Ruff, S.M.; Mohseni, A.; Kamel, I.R.; Cloyd, J.M.; Pawlik, T.M. Management of hepatocellular carcinoma: A review. JAMA Surg. 2023, 158, 410–420. [Google Scholar] [CrossRef] [PubMed]
- Raoul, J.L.; Forner, A.; Bolondi, L.; Cheung, T.T.; Kloeckner, R.; de Baere, T. Updated use of TACE for hepatocellular carcinoma treatment: How and when to use it based on clinical evidence. Cancer Treat. Rev. 2019, 72, 28–36. [Google Scholar] [CrossRef]
- Duan, R.; Gong, F.; Wang, Y.; Huang, C.; Wu, J.; Hu, L.; Liu, M.; Qiu, S.; Lu, L.; Lin, Y. Transarterial chemoembolization (TACE) plus tyrosine kinase inhibitors versus TACE in patients with hepatocellular carcinoma: A systematic review and meta-analysis. World J. Surg. Oncol. 2023, 21, 120. [Google Scholar] [CrossRef]
- Fan, W.; Zhu, B.; Chen, S.; Wu, Y.; Zhao, X.; Qiao, L.; Huang, Z.; Tang, R.; Chen, J.; Lau, W.Y. Survival in Patients with Recurrent Intermediate-Stage Hepatocellular Carcinoma: Sorafenib Plus TACE vs TACE Alone Randomized Clinical Trial. JAMA Oncol. 2024, 10, 1047–1054. [Google Scholar] [CrossRef]
- Lee, H.N.; Hyun, D. Complications related to transarterial treatment of hepatocellular carcinoma: A comprehensive review. Korean J. Radiol. 2023, 24, 204–223. [Google Scholar] [CrossRef]
- Saketkoo, L.A.; Russell, A.; Jensen, K.; Mandizha, J.; Tavee, J.; Newton, J.; Rivera, F.; Howie, M.; Reese, R.; Goodman, M. Health-related quality of life (HRQoL) in sarcoidosis: Diagnosis, management, and health outcomes. Diagnostics 2021, 11, 1089. [Google Scholar] [CrossRef]
- Jayabalan, D.; Dhakal, S.; Raguragavan, A.; Saxena, A.; Jeffrey, G.P.; Calzadilla-Bertot, L.; Adams, L.A.; Wallace, M.C. Hepatocellular Carcinoma and Health-Related Quality of Life: A Systematic Review of Outcomes from Systemic Therapies. Int. J. Hepatol. 2025, 2025, 1083642. [Google Scholar] [CrossRef]
- Sharma, A.; Stan, M.N.; Rootman, D.B. Measuring Health-Related Quality of Life in Thyroid Eye Disease. J. Clin. Endocrinol. Metab. 2022, 107, S27–S35. [Google Scholar] [CrossRef]
- Chen, N.Y.; Chen, K.H.; Wang, Y.W.; Tsai, H.H.; Lee, W.C.; Weng, L.C. The impact of symptom distress on health-related quality of life in liver cancer patients receiving arterial chemoembolization: The mediating role of hope. BMC Gastroenterol. 2022, 22, 456. [Google Scholar] [CrossRef] [PubMed]
- George, S.; Devadas, K.; Sudheendran, P.T.; Sreesh, S.; Safeer, S.; Skariah, J.J.; George, A.M.; Visruthakumar, A.N.; Sivakumar, G.; Kumar, M.S. Effect of Transarterial Chemoembolization on Health-Related Quality of Life in Patients with Hepatocellular Carcinoma. Cureus. 2025, 17, e82531. [Google Scholar] [CrossRef] [PubMed]
- Mitchell, K.R.; Brassil, K.J.; Rodriguez, S.A.; Tsai, E.; Fujimoto, K.; Krause, K.J.; Shay, L.A.; Springer, A.E. Operationalizing patient-centered cancer care: A systematic review and synthesis of the qualitative literature on cancer patients’ needs, values, and preferences. Psychooncology. 2020, 29, 1723–1733. [Google Scholar] [CrossRef] [PubMed]
- Xu, W.; Zhu, Z.; Yu, J.; Li, J.; Lu, H. Symptoms experienced after transcatheter arterial chemoembolization in patients with primary liver cancer: A network analysis. Asia Pac. J. Oncol. Nurs. 2024, 11, 100361. [Google Scholar] [CrossRef]
- Pathomjaruwat, T.; Matchim, Y.; Armer, J.M. Symptoms and symptom clusters in patients with hepatocellular carcinoma and commonly used instruments: An integrated review. Int. J. Nurs. Sci. 2024, 11, 66–75. [Google Scholar] [CrossRef]
- Page, M.J.; McKenzie, J.E.; Bossuyt, P.M.; Boutron, I.; Hoffmann, T.C.; Mulrow, C.D.; Shamseer, L.; Tetzlaff, J.M.; Akl, E.A.; Brennan, S.E.; et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ (Clin. Res. Ed.) 2021, 372, n71. [Google Scholar]
- Barker, T.H.; Stone, J.C.; Sears, K.; Klugar, M.; Leonardi-Bee, J.; Tufanaru, C.; Aromataris, E.; Munn, Z. Revising the JBI quantitative critical appraisal tools to improve their applicability: An overview of methods and the development process. JBI Evid. Synth. 2023, 21, 478–493. [Google Scholar] [CrossRef]
- Barker, T.H.; Hasanoff, S.; Aromataris, E.; Stone, J.C.; Leonardi-Bee, J.; Sears, K.; Habibi, N.; Klugar, M.; Tufanaru, C.; Moola, S. The revised JBI critical appraisal tool for the assessment of risk of bias for cohort studies. JBI Evid. Synth. 2025, 23, 441–453. [Google Scholar] [CrossRef]
- Munn, Z.; Dias, M.; Tufanaru, C.; Porritt, K.; Stern, C.; Jordan, Z.; Aromataris, E.; Pearson, A. The “quality” of JBI qualitative research synthesis: A methodological investigation into the adherence of meta-aggregative systematic reviews to reporting standards and methodological guidance. JBI Evid. Synth. 2021, 19, 1119–1139. [Google Scholar] [CrossRef] [PubMed]
- Hartrumpf, K.J.; Marquardt, S.; Werncke, T.; Murray, T.; Kirstein, M.M.; Vogel, A.; Wacker, F.; Rodt, T. Quality of life in patients undergoing repetitive TACE for the treatment of intermediate stage HCC. J. Cancer Res. Clin. Oncol. 2018, 144, 1991–1999. [Google Scholar] [CrossRef]
- Hinrichs, J.B.; Hasdemir, D.B.; Nordlohne, M.; Schweitzer, N.; Wacker, F.; Vogel, A.; Kirstein, M.M.; Marquardt, S.; Rodt, T. Health-Related Quality of Life in Patients with Hepatocellular Carcinoma Treated with Initial Transarterial Chemoembolization. Cardiovasc. Intervent. Radiol. 2017, 40, 1559–1566. [Google Scholar] [CrossRef] [PubMed]
- Shun, S.C.; Chen, C.H.; Sheu, J.C.; Liang, J.D.; Yang, J.C.; Lai, Y.H. Quality of life and its associated factors in patients with hepatocellular carcinoma receiving one course of transarterial chemoembolization treatment: A longitudinal study. Oncologist 2012, 17, 732–739. [Google Scholar] [CrossRef] [PubMed]
- Eltawil, K.M.; Berry, R.; Abdolell, M.; Molinari, M. Quality of life and survival analysis of patients undergoing transarterial chemoembolization for primary hepatic malignancies: A prospective cohort study. HPB 2012, 14, 341–350. [Google Scholar] [CrossRef] [PubMed]
- Zhao, M.; Zhu, T.; Huang, M. Quality of life and its influencing factors in elderly patients with primary hepatic carcinoma after transcatheter arterial chemoembolization. Chin. J. Mult. Organ Dis. Elder. 2024, 23, 599–602. [Google Scholar]
- Zheng, D.N.; Sun, G.P. An Investigation of Health-Related Quality of Life in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization. Med. Inf. 2020, 33, 127–130. [Google Scholar]
- Liu, X.; Du, D.D.; Ping, X.S. Quality of Life and Its Influencing Factors in Patients with Hepatocellular Carcinoma After Transarterial Chemoembolization. Chin. Gen. Pract. Nurs. 2020, 18, 1757–1759. [Google Scholar]
- Cao, W.t.; Hu, C.; Li, J.; Shen, J.; Liu, X.y.; Xu, Y. Study on Symptom Experience and Quality of Life in Patients Treated with Transarterial Chemoembolization. J. Nurs. Sci. 2012, 27, 49–51. [Google Scholar]
- You, X.; Lu, F.; Li, F.; Zhao, F.; Huo, R. Dynamics trajectory of patient-reported quality of life and its associated risk factors among hepatocellular carcinoma patients receiving immune checkpoint inhibitors: A prospective cohort study. Front. Immunol. 2024, 15, 1463655. [Google Scholar] [CrossRef]
- George, M.; Smith, A.; Sabesan, S.; Ranmuthugala, G. Physical comorbidities and their relationship with cancer treatment and its outcomes in older adult populations: Systematic review. JMIR Cancer 2021, 7, e26425. [Google Scholar] [CrossRef]
- Fonseca, A.F.; Lahoz, R.; Proudfoot, C.; Corda, S.; Loefroth, E.; Jackson, J.; Cotton, S.; Studer, R. Burden and quality of life among female and male patients with heart failure in Europe: A real-world cross-sectional study. Patient Prefer. Adherence 2021, 15, 1693–1706. [Google Scholar] [CrossRef]
- Lin, M.; Chen, L.; Huang, S.; Meng, L.; Lee, W.; Peng, L.; Hsiao, F.; Chen, L. Age and sex differences in associations between self-reported health, physical function, mental function and mortality. Arch. Gerontol. Geriatr. 2022, 98, 104537. [Google Scholar] [CrossRef] [PubMed]
- Blumer, V.; Greene, S.J.; Wu, A.; Butler, J.; Ezekowitz, J.A.; Lindenfeld, J.; Alhanti, B.; Hernandez, A.F.; O’Connor, C.M.; Mentz, R.J. Sex differences in clinical course and patient-reported outcomes among patients hospitalized for heart failure. Heart Fail. 2021, 9, 336–345. [Google Scholar] [CrossRef] [PubMed]
- Zou, H.; Li, M.; Lei, Q.; Luo, Z.; Xue, Y.; Yao, D.; Lai, Y.; Ung, C.O.L.; Hu, H. Economic burden and quality of life of hepatocellular carcinoma in greater China: A systematic review. Front. Public Health 2022, 10, 801981. [Google Scholar] [CrossRef] [PubMed]
- Amin, S.M.; Khedr, M.A.; Tawfik, A.F.; Gamal Noaman Malek, M.; El-Ashry, A.M. The mediating and moderating role of social support on the relationship between psychological well-being and burdensomeness among elderly with chronic illness: Community nursing perspective. BMC Nurs. 2025, 24, 156. [Google Scholar] [CrossRef]
- Ramasubbu, S.K.; Pasricha, R.K.; Nath, U.K.; Rawat, V.S.; Das, B. Quality of life and factors affecting it in adult cancer patients undergoing cancer chemotherapy in a tertiary care hospital. Cancer Rep. 2021, 4, e1312. [Google Scholar] [CrossRef]
- Han, C.J.; Rosko, A.E.; Spakowicz, D.J.; Hammer, M.J.; Von Ah, D. Associations of frailty with symptoms, and HRQOL in older cancer survivors after cancer treatments: A systematic review and meta-analyses. Qual. Life Res. 2024, 33, 583–598. [Google Scholar] [CrossRef]
- Verma, M.; Paik, J.M.; Younossi, I.; Tan, D.; Abdelaal, H.; Younossi, Z.M. The impact of hepatocellular carcinoma diagnosis on patients’ health-related quality of life. Cancer Med. 2021, 10, 6273–6281. [Google Scholar] [CrossRef]
- El-Khateeb, E.; Darwich, A.S.; Achour, B.; Athwal, V.; Rostami-Hodjegan, A. time to revisit Child-Pugh score as the basis for predicting drug clearance in hepatic impairment. Aliment. Pharmacol. Ther. 2021, 54, 388–401. [Google Scholar] [CrossRef]
- Wei, Z.; Zhang, Y. Transcatheter arterial chemoembolization followed by surgical resection for hepatocellular carcinoma: A focus on its controversies and screening of patients most likely to benefit. Chin. Med. J. 2021, 134, 2275–2286. [Google Scholar] [CrossRef]
- Muzellec, L.; Bourien, H.; Edeline, J. Patients’ experience of systemic treatment of hepatocellular carcinoma: A review of the impact on quality of life. Cancers 2021, 14, 179. [Google Scholar] [CrossRef]
- Xu, Z.; Liu, Y.; Yang, J.; Li, F.; Liu, W. Recent Advances of Metal Complexes in the Treatment of Hepatocellular Carcinoma. J. Med. Chem. 2024, 68, 1–17. [Google Scholar] [CrossRef] [PubMed]
- Reincke, M.; Schultheiss, M.; Doppler, M.; Verloh, N.; Uller, W.; Sturm, L.; Thimme, R.; Goetz, C.; Bettinger, D. Hepatic decompensation after transarterial radioembolization: A retrospective analysis of risk factors and outcome in patients with hepatocellular carcinoma. Hepatol. Commun. 2022, 6, 3223–3233. [Google Scholar] [CrossRef] [PubMed]
- Müller, L.; Kloeckner, R.; Mähringer-Kunz, A.; Stoehr, F.; Düber, C.; Arnhold, G.; Gairing, S.J.; Foerster, F.; Weinmann, A.; Galle, P.R. Fully automated AI-based splenic segmentation for predicting survival and estimating the risk of hepatic decompensation in TACE patients with HCC. Eur. Radiol. 2022, 32, 6302–6313. [Google Scholar] [CrossRef] [PubMed]
- Tampaki, M.; Papatheodoridis, G.V.; Cholongitas, E. Management of hepatocellular carcinoma in decompensated cirrhotic patients: A comprehensive overview. Cancers 2023, 15, 1310. [Google Scholar] [CrossRef]
- Alem, Z.; Murray, T.E.; Egri, C.; Chung, J.; Liu, D.; Elsayes, K.M.; Chang, S.D.; Harris, A. Treatment response assessment following transarterial radioembolization for hepatocellular carcinoma. Abdom. Radiol. 2021, 46, 3596–3614. [Google Scholar] [CrossRef]
- Charoenvisal, C.; Tanaka, T.; Nishiofuku, H.; Anai, H.; Sato, T.; Matsumoto, T.; Marugami, N.; Kichikawa, K. Feasibility and techniques of securing 3D-safety margin in superselective transarterial chemoembolization to improve local tumor control for small hepatocellular carcinoma: An intend-to-treat analysis. Liver Cancer 2021, 10, 63–71. [Google Scholar] [CrossRef]
- Blackstone, B.; Patel, R.; Bewley, A. Assessing and improving psychological well-being in psoriasis: Considerations for the clinician. Psoriasis Targets Ther. 2022, 12, 25–33. [Google Scholar] [CrossRef]
- Nagy, D.S.; Isaic, A.; Motofelea, A.C.; Popovici, D.I.; Diaconescu, R.G.; Negru, S.M. The Role of Spirituality and Religion in Improving Quality of Life and Coping Mechanisms in Cancer Patients. Healthcare 2024, 12, 2349. [Google Scholar] [CrossRef]
- Zheng, Y.; Zhang, X.; Lu, J.; Liu, S.; Qian, Y. Association between socioeconomic status and survival in patients with hepatocellular carcinoma. Cancer Med. 2021, 10, 7347–7359. [Google Scholar] [CrossRef]
- Cui, P.; Yang, M.; Hu, H.; Cheng, C.; Chen, X.; Shi, J.; Li, S.; Chen, C.; Zhang, H. The impact of caregiver burden on quality of life in family caregivers of patients with advanced cancer: A moderated mediation analysis of the role of psychological distress and family resilience. BMC Public Health 2024, 24, 817. [Google Scholar] [CrossRef]
- Wang, T.; Wu, N.; Wang, S.; Liu, Y. The relationship between psychological resilience, perceived social support, acceptance of illness and mindfulness in patients with hepatolenticular degeneration. Sci. Rep. 2025, 15, 1–13. [Google Scholar] [CrossRef] [PubMed]
- Du, Q.; Liang, M.; Jiang, B.; Zhang, M.; Yu, X.; Li, X.; Hao, J. Incidence and predictors of abdominal pain after transarterial chemoembolization of hepatocellular carcinoma: A single-center retrospective study. Eur. J. Oncol. Nurs. 2023, 66, 102355. [Google Scholar] [CrossRef] [PubMed]
- Thanakunchai, T.; Hongthanakorn, C. Prevalence and Risk Factors of Post-chemoembolization Syndrome After Chemo-Embolization for Hepatocellular Carcinoma in Thailand. Dig. Dis. Sci. 2023, 68, 3818–3823. [Google Scholar] [CrossRef] [PubMed]
- Ierardi, A.M.; Ascenti, V.; Lanza, C.; Carriero, S.; Amato, G.; Pellegrino, G.; Giurazza, F.; Torcia, P.; Carrafiello, G. Is it a complication or a consequence-a new perspective on adverse outcomes in Interventional Radiology. CVIR Endovasc. 2024, 7, 6. [Google Scholar] [CrossRef]
- Granito, A.; Facciorusso, A.; Sacco, R.; Bartalena, L.; Mosconi, C.; Cea, U.V.; Cappelli, A.; Antonino, M.; Modestino, F.; Brandi, N.; et al. TRANS-TACE: Prognostic Role of the Transient Hypertransaminasemia after Conventional Chemoembolization for Hepatocellular Carcinoma. J. Pers. Med. 2021, 11, 1041. [Google Scholar] [CrossRef]
- Zhang, W.; Chin, K.; Zakaria, R.; Hassan, N.H. Strategies for Pain Management in Hepatocellular Carcinoma Patients Undergoing Transarterial Chemoembolisation: A Scoping Review of Current Evidence. Healthcare 2025, 13, 994. [Google Scholar] [CrossRef]
- Cocks, K.; Wells, J.R.; Johnson, C.; Schmidt, H.; Koller, M.; Oerlemans, S.; Velikova, G.; Pinto, M.; Tomaszewski, K.A.; Aaronson, N.K.; et al. Content validity of the EORTC quality of life questionnaire QLQ-C30 for use in cancer. Eur. J. Cancer 2023, 178, 128–138. [Google Scholar] [CrossRef]
- Pyo, E.; Weber, M.B.; Sivaram, J.; Staimez, L.R.; Mohan, V.; Anjana, R.M.; Haardörfer, R.; Ranjani, H. Construct validity of the 12-item Short Form Health Survey (SF-12) version 2 and the impact of lifestyle modifications on the health-related quality of life among Indian adults with prediabetes: Results from the D-CLIP trial. Qual. Life Res. 2024, 33, 1593–1603. [Google Scholar] [CrossRef]
- Hassanin, T.M.; Fouad, Y.; Hassnine, A.; Eisawy, M.; Farag, N.; Ghany, W.A. Quality of life after transcatheter arterial chemoembolization combined with radiofrequency ablation in patients with unresectable hepatocellular carcinoma compared with transcatheter arterial chemoembolization alone. Asian Pac. J. Cancer Prev. APJCP 2021, 22, 1255. [Google Scholar] [CrossRef]
- Lanza, C.; Ascenti, V.; Amato, G.V.; Pellegrino, G.; Triggiani, S.; Tintori, J.; Intrieri, C.; Angileri, S.A.; Biondetti, P.; Carriero, S. All You Need to Know About TACE: A Comprehensive Review of Indications, Techniques, Efficacy, Limits, and Technical Advancement. J. Clin. Med. 2025, 14, 314. [Google Scholar] [CrossRef]
- Fan, W.; Guo, J.; Zhu, B.; Wang, S.; Yu, L.; Huang, W.; Fan, H.; Li, F.; Wu, Y.; Zhao, Y. Drug-eluting beads TACE is safe and non-inferior to conventional TACE in HCC patients with TIPS. Eur. Radiol. 2021, 31, 8291–8301. [Google Scholar] [CrossRef] [PubMed]
- Roehlen, N.; Stoehr, F.; Müller, L.; Luxenburger, H.; Gairing, S.J.; Reincke, M.; Schultheiss, M.; Berisha, F.; Weinmann, A.; Foerster, F.; et al. Prediction of postembolization syndrome after transarterial chemoembolization of hepatocellular carcinoma and its impact on prognosis. Hepatol. Commun. 2023, 7, e0252. [Google Scholar] [CrossRef] [PubMed]
- Li, H.; Liang, C.; Kuang, D.; Huang, G.; Zhang, M.; Chen, P.; Zheng, Q.; Xu, W.; Ren, J.; Han, X. The impact of drug-eluting bead (vs. conventional) transarterial chemoembolization on hepatic fibrosis in treating intermediate or advanced hepatocellular carcinoma. Cancer Biol. Ther. 2023, 24, 2166335. [Google Scholar] [CrossRef] [PubMed]
- Sun, X.; Liu, X.; Zhang, B.; Wang, Y.; Fan, L. Impact of spiritual care on the spiritual and mental health and quality of life of patients with advanced cancer. World J. Psychiatry 2021, 11, 449. [Google Scholar] [CrossRef]
- Chen, J.; You, H.; Liu, Y.; Kong, Q.; Lei, A.; Guo, X. Association between spiritual well-being, quality of life, anxiety and depression in patients with gynaecological cancer in China. Medicine 2021, 100, e24264. [Google Scholar] [CrossRef]
- Laube, R.; Sabih, A.; Strasser, S.I.; Lim, L.; Cigolini, M.; Liu, K. Palliative care in hepatocellular carcinoma. J. Gastroenterol. Hepatol. 2021, 36, 618–628. [Google Scholar] [CrossRef]
- Beresford, C.J.; Gelling, L.; Baron, S.; Thompson, L. The experiences of people with liver disease of palliative and end-of-life care in the United Kingdom—A systematic literature review and metasynthesis. Health Expect. 2024, 27, e13893. [Google Scholar] [CrossRef]
Author | Country | Year | Study Design | Sample Size | Follow-Up Duration |
---|---|---|---|---|---|
Hartrumpf et al. [20] | Germany | 2018 | Cohort | 148 | 2 weeks |
Hinrichs et al. [21] | Germany | 2017 | Cohort | 79 | 2 weeks |
Chen et al. [11] | Taiwan, China | 2022 | Cross-sectional | 98 | 2 months |
Shun et al. [22] | Taiwan, China | 2012 | Cohort | 89 | 2 months |
Eltawil et al. [23] | Canada | 2012 | Cohort | 48 | 12 months |
Zhao et al. [24] | China | 2024 | Cohort | 348 | 3 months |
Zheng et al. [25] | China | 2020 | Cohort | 130 | 6 weeks |
Liu et al. [26] | China | 2020 | Cross-sectional | 161 | postoperative day 3 |
Cao et al. [27] | China | 2012 | Cross-sectional | 142 | postoperative day 3 |
Author | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | % Yes | Quality Level | Include | Key Methodological Weaknesses |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Hartrumpf et al. [20] | Y | Y | N | Y | Y | Y | Y | Y | U | U | U | Y | 66.7% | M | ✔ | Exposure measurement inconsistency between groups Incomplete follow-up reporting |
Hinrichs et al. [21] | Y | Y | N | Y | Y | Y | Y | Y | U | U | U | Y | 80% | M | ✔ | same as above |
Shun et al. [22] | Y | Y | N | Y | Y | Y | Y | Y | Y | U | U | Y | 75% | H | ✔ | same as above |
Eltawil et al. [23] | Y | Y | N | Y | Y | Y | Y | Y | Y | U | U | Y | 75% | H | ✔ | same as above |
Zhao et al. [24] | Y | Y | N | Y | Y | Y | Y | Y | Y | U | U | Y | 75% | H | ✔ | same as above |
Zheng et al. [25] | Y | Y | N | Y | Y | Y | Y | Y | Y | U | U | Y | 75% | H | ✔ | same as above |
Author and Year | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | % Yes | Quality Level | Included | Key Methodological Weaknesses |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Chen et al. [11] | Y | Y | Y | Y | N | N | Y | Y | 75% | H | ✔ | Confounding factors not identified No strategies to address confounding |
Liu et al. [26] | Y | Y | Y | Y | Y | N | Y | Y | 87.5% | H | ✔ | No strategies to address confounding |
Cao et al. [27] | Y | Y | Y | Y | N | N | Y | Y | 75% | H | ✔ | Confounding factors not identified No strategies to address confounding |
Author | Country | Year | HRQoL Tool | Assessment Time Point | Specific Domains Reported |
---|---|---|---|---|---|
Hartrumpf et al. [20] | Germany | 2018 | EORTC QLQ-C30 EORTC QLQ-HCC18 | Pre-TACE 14 days post-TACE | Global health status Physical functioning Symptom scales: pain, nausea and vomiting, fever |
Hinrichs et al. [21] | Germany | 2017 | EORTC QLQ-C30EORTC QLQ-HCC18 | Pre-TACE 2 weeks post-TACE | Global health score Physical functioning Role functioning Social functioning Symptoms: fatigue, loss of appetite, pain, nausea and vomiting, abdominal swelling |
Chen et al. [11] | Taiwan, China | 2022 | FACT-G | Discharge day post-TACE | Physical well-being Social and family well-being Emotional well-being Functional well-being |
Shun et al. [22] | Taiwan, China | 2012 | SF-12 | Within 3 days prior to discharge 4 weeks after discharge 8 weeks after discharge | PCS: Physical functioning Role physical Bodily pain General health MCS: Vitality Social functioning Role emotional Mental health |
Eltawil et al. [23] | Canada | 2012 | WHOQOL-BREF | Pre-TACE Every 3 months post-TACE over a 12-month follow-up | Physical health Psychological health Social relationship Environmental health |
Zhao et al. [24] | China | 2024 | EORTC QLQ-C30 | Pre-TACE 3 months post-discharge | Global health status Physical functioning Symptom scales: pain, nausea and vomiting, fever |
Zheng et al. [25] | China | 2020 | QoL-LC V2.0 | Pre-TACE 6 weeks post-TACE | Physical functioning Psychological functioning Symptoms and impact Social functioning |
Liu et al. [26] | China | 2020 | QOL-LC V2.0 FACIT-Sp12 | 3 days post-TACE | Physical functioning Psychological functioning Symptoms Social functioning |
Cao et al. [27] | China | 2012 | FACT-G | 3 days post-TACE | Physical well-being Social and family well-being Emotional well-being Functional well-being |
Tool | Score Range | Scoring Interpretation | Number of Items | Domain | Author and Year |
---|---|---|---|---|---|
EORTC QLQ-C30 (n = 3 studies) | 0–100 per domain | Higher functional scores = better HRQoL; higher symptom scores = worse symptoms. | 30 | Physical Role Emotional Cognitive Social | Hartrumpf et al., 2018 [20]; Hinrichs et al., 2017 [21]; Zhao et al., 2024 [24] |
EORTC QLQ-HCC18 (n = 2 studies) | 0–100 per domain | Higher functional scores = better HRQoL; higher symptom scores = worse symptoms. | 18 | Fatigue Body image Jaundice Nutrition Pain Fever Abdominal Swelling | Hartrumpf et al., 2018 [20]; Hinrichs et al., 2017 [21] |
FACT-G (n = 2 studies) | 0–108 | The final score is calculated by adding all subscale scores. HRQoL improves with higher overall scores. | 27 | Physical well-being Social and family well-being Emotional well-being Functional well-being | Chen et al., 2022 [11]; Cao et al., 2012 [27] |
QoL-LC V2.0 (n = 2 studies) | 0–100 per domain | More points mean greater HRQoL. Each item was assessed on a 5-point Likert scale (1 = not at all to 5 = very lot) and then converted to a 0–100 scale. | 35 | Physical function Psychological function social function Common symptoms and side Effects Specific Symptoms of liver cancer | Zheng et al., 2020 [25]; Liu et al., 2020 [26] |
SF-12 (n = 1 study) | 0–100 | More points mean better health. The norm-based PCS and MCS scores are standardized to the general population. The mean score is 50, while the standard deviation is 10. | 12 | PCS: Physical functioning Role physical Bodily pain General health MCS: Vitality Social functioning Role emotional Mental health | Shun et al., 2012 [22] |
WHOQOL-BREF (n = 1 study) | 4–20 for each domain; 0–100 for overall HRQoL | HRQoL improves with higher scores. Higher scores indicate better health, functioning, or well-being in each domain. The 4–20 range is converted to a 0–100 scale to calculate HRQoL. | 26 | Physical health Psychological health Social relationshipEnvironmental health | Eltawil et al., 2012 [23] |
FACIT-Sp12 (n = 1 study) | 0–48 | Higher scores indicate better levels of spiritual well-being. | 12 | Spiritual Well-Being | Liu et al., 2020 [26] |
Author and Year | Positive Predictors | Negative Predictors |
---|---|---|
Hartrumpf et al., 2018 [20] | Education level, marital status, employment status | Fatigue, pain, anxiety, depression, symptom distress |
Hinrichs et al., 2017 [21] | Physical functioning, role functioning | Fatigue, pain, anxiety, depression |
Chen et al., 2022 [11] | NA | Age, gender, depression, symptom distress, Disease status |
Shun et al., 2012 [22] | Stable AFP levels, MELD score | Tumor size |
Eltawil et al., 2012 [23] | Disease awareness | Age, previous liver cancer surgery |
Zhao et al., 2024 [24] | Spiritual health | Gender, living location, family income, pain, Hepatitis B history, family cancer history |
Zheng et al., 2020 [25] | Family support | Older age, Child–Pugh classification (worse liver function), liver pain, TNM stage |
Liu et al., 2020 [26] | Spiritual health | Gender, residence, family income, hepatitis history, family cancer history, pain |
Cao et al., 2012 [27] | NA | Pain, sadness, appetite loss, abdominal bloating, fatigue |
Category | Influencing Factors | Author and Year |
---|---|---|
Demographic factors | Age Gender Education Level Marital Status Employment Status Living Location Family Support | Chen et al., 2022 [11]; Shun et al., 2012 [22]; Zhao et al., 2024 [24]; Zheng et al., 2020 [25]; Liu et al., 2020 [26] |
Clinical factors | TACE treatment Tumor type Tumor size Child-Pugh classification TNM stage History of hepatitis or liver resection | Hartrumpf et al., 2018 [20]; Chen et al., 2022 [11]; Zhao et al., 2024 [24]; Cao et al., 2012 [27] |
Psychological factors | Anxiety Depression Sadness Spiritual health Coping mechanisms | Hartrumpf et al., 2018 [20]; Shun et al., 2012 [22]; Zhao et al., 2024 [24]; Cao et al., 2012 [27] |
Social support factors | Family income Family support Social support | Zhao et al., 2024 [24]; Zheng et al., 2020 [25] |
Physical factors | Fatigue Abdominal distension Pain Appetite loss | Chen et al., 2022 [11]; Cao et al., 2012 [27] |
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Zhang, W.-Z.; Han, J.-Q.; Chin, K.-Y.; Zakaria, R.; Hassan, N.H. Determinants of Health-Related Quality of Life After Transarterial Chemoembolization in Hepatocellular Carcinoma Patients: A Systematic Review. J. Clin. Med. 2025, 14, 3941. https://doi.org/10.3390/jcm14113941
Zhang W-Z, Han J-Q, Chin K-Y, Zakaria R, Hassan NH. Determinants of Health-Related Quality of Life After Transarterial Chemoembolization in Hepatocellular Carcinoma Patients: A Systematic Review. Journal of Clinical Medicine. 2025; 14(11):3941. https://doi.org/10.3390/jcm14113941
Chicago/Turabian StyleZhang, Wei-Zheng, Jin-Qian Han, Kok-Yong Chin, Roshaya Zakaria, and Nor Haty Hassan. 2025. "Determinants of Health-Related Quality of Life After Transarterial Chemoembolization in Hepatocellular Carcinoma Patients: A Systematic Review" Journal of Clinical Medicine 14, no. 11: 3941. https://doi.org/10.3390/jcm14113941
APA StyleZhang, W.-Z., Han, J.-Q., Chin, K.-Y., Zakaria, R., & Hassan, N. H. (2025). Determinants of Health-Related Quality of Life After Transarterial Chemoembolization in Hepatocellular Carcinoma Patients: A Systematic Review. Journal of Clinical Medicine, 14(11), 3941. https://doi.org/10.3390/jcm14113941