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A differential risk assessment and decision model for Transarterial chemoembolization in hepatocellular carcinoma based on hepatic function
- A differential risk assessment and decision model for Transarterial chemoembolization in hepatocellular carcinoma based on hepatic function
- Nam, Joon Yeul; Choe, A. Reum; Sinn, Dong Hyun; Lee, Jeong-Hoon; Kim, Hwi Young; Yu, Su Jong; Kim, Yoon Jun; Yoon, Jung-Hwan; Lee, Jeong Min; Chung, Jin Wook; Choi, Sun Young; Lee, Jeong Kyong; Baek, Seung Yon; Lee, Hye Ah; Kim, Tae Hun; Yoo, Kwon
- Ewha Authors
- 백승연; 유권; 이정경; 김태헌; 최선영; 김휘영; 이혜아; 남준열; 최아름
- SCOPUS Author ID
- 백승연; 유권; 이정경; 김태헌; 최선영; 김휘영; 이혜아
- Issue Date
- Journal Title
- BMC CANCER
- BMC CANCER vol. 20, no. 1
- Hepatocellular carcinoma; Transarterial chemoembolization; Child-Pugh classification; Risk prediction model
- SCIE; SCOPUS
- Document Type
- 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.
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