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

Title
A differential risk assessment and decision model for Transarterial chemoembolization in hepatocellular carcinoma based on hepatic function
Authors
Nam, Joon YeulChoe, A. ReumSinn, Dong HyunLee, Jeong-HoonKim, Hwi YoungYu, Su JongKim, Yoon JunYoon, Jung-HwanLee, Jeong MinChung, Jin WookChoi, Sun YoungLee, Jeong KyongBaek, Seung YonLee, Hye AhKim, Tae HunYoo, Kwon
Ewha Authors
백승연유권이정경김태헌최선영김휘영이혜아남준열최아름
SCOPUS Author ID
백승연scopus; 유권scopus; 이정경scopus; 김태헌scopus; 최선영scopus; 김휘영scopus; 이혜아scopus
Issue Date
2020
Journal Title
BMC CANCER
ISSN
1471-2407JCR Link
Citation
BMC CANCER vol. 20, no. 1
Keywords
Hepatocellular carcinomaTransarterial chemoembolizationChild-Pugh classificationRisk prediction model
Publisher
BMC
Indexed
SCIE; SCOPUS WOS
Document Type
Article
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.
DOI
10.1186/s12885-020-06975-2
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의과대학 > 의학과 > Journal papers
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