BMC Cancer. 2020;20(1):504.

A differential risk assessment and decision model for Transarterial chemoembolization in hepatocellular carcinoma based on hepatic function.

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제1저자 남준열, 최아름, 신동현 · 교신저자 이정훈, 김휘영

PMID 32487089 PMC7268402 DOI 10.1186/s12885-020-06975-2 IF 4.1 소화기내과

소속 (8)

Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea.
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. pindra@empal.com.
Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea. hwiyoung@ewha.ac.kr.
Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.

Abstract

BACKGROUND The decision of transarterial chemoembolization (TACE) initiation and/or repetition remains challenging in patients with unresectable hepatocellular carcinoma (HCC). The aim was to develop a prognostic scoring system to guide TACE initiation/repetition.

METHODS A total of 597 consecutive patients who underwent TACE as their initial treatment for unresectable HCC were included. We derived a prediction model using independent risk factors for overall survival (OS), which was externally validated in an independent cohort (n = 739).

RESULTS Independent risk factors of OS included Albumin-bilirubin (ALBI) grade, maximal tumor size, alpha-fetoprotein, and tumor response to initial TACE, which were used to develop a scoring system ("ASAR"). C-index values for OS were 0.733 (95% confidence interval [CI] = 0.570-0.871) in the derivation, 0.700 (95% CI = 0.445-0.905) in the internal validation, and 0.680 (95% CI = 0.652-0.707) in the external validation, respectively. Patients with ASAR< 4 showed significantly longer OS than patients with ASAR≥4 in all three datasets (all P < 0.001). Among Child-Pugh class B patients, a modified model without TACE response, i.e., "ASA(R)", discriminated OS with a c-index of 0.788 (95% CI, 0.703-0.876) in the derivation, and 0.745 (95% CI, 0.646-0.862) in the internal validation, and 0.670 (95% CI, 0.605-0.725) in the external validation, respectively. Child-Pugh B patients with ASA(R) < 4 showed significantly longer OS than patients with ASA(R) ≥ 4 in all three datasets (all P < 0.001).

CONCLUSIONS ASAR provides refined prognostication for repetition of TACE in patients with unresectable HCC. For Child-Pugh class B patients, a modified model with baseline factors might guide TACE initiation.

Keywords

Child-Pugh classificationHepatocellular carcinomaRisk prediction modelTransarterial chemoembolization

Figures

**Fig. 1** Consort diagram. A total of 763 HCC patients who received TACE as initial treatment for unresectable HCC were enrolled from two large-volume university hospitals. Of these, 166 patients were excluded and 597 patients were enrolled for analysis. A total of 739 HCC patients from independent university hospital were enrolled to validate the model externally

**Fig. 2** (a-c) Survival analyses of the derivation and validation set according to ASAR score. ASAR scores (cut-off = 4) offered similar predictive performance of overall survival in the internal and external validation set compared to that in the derivation set

**Fig. 3** (a-c) Survival analyses of subgroups according to Child-Pugh class with ASAR score in the entire cohort. When applying ASAR score (cut-off = 4), overall survivals were significantly different in all enrolled patients as well as in patients with Child-Pugh class A or B

**Fig. 4** (a-c) Overall survival in patients with Child-Pugh class B according to the modified model without initial TACE response (ALBI, size of tumor, and AFP) in the derivation and validation sets. When applying the modified model (cut-off = 4) score only in patients with Child-Pugh class B, overall survivals were significantly different in patients in the derivation and the internal and external validation sets

그림 출처: PubMed Central 공개 논문 (PMC7268402)

Conflict of interest statement

The authors declare that they have no competing interests.

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