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

Joon Yeul Nam, A. Reum Choe, Dong Hyun Sinn, Jeong Hoon Lee, Hwi Young Kim, Su Jong Yu, Yoon Jun Kim, Jung Hwan Yoon, Jeong Min Lee, Jin Wook Chung, Sun Young Choi, Jeong Kyong Lee, Seung Yon Baek, Hye Ah Lee, Tae Hun Kim, Kwon Yoo

Research output: Contribution to journalArticle

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.

Original languageEnglish
Article number504
JournalBMC Cancer
Volume20
Issue number1
DOIs
StatePublished - 1 Jun 2020

Keywords

  • Child-Pugh classification
  • Hepatocellular carcinoma
  • Risk prediction model
  • Transarterial chemoembolization

Fingerprint Dive into the research topics of 'A differential risk assessment and decision model for Transarterial chemoembolization in hepatocellular carcinoma based on hepatic function'. Together they form a unique fingerprint.

  • Cite this

    Nam, J. Y., Choe, A. R., Sinn, D. H., Lee, J. H., Kim, H. Y., Yu, S. J., Kim, Y. J., Yoon, J. H., Lee, J. M., Chung, J. W., Choi, S. Y., Lee, J. K., Baek, S. Y., Lee, H. A., Kim, T. H., & Yoo, K. (2020). A differential risk assessment and decision model for Transarterial chemoembolization in hepatocellular carcinoma based on hepatic function. BMC Cancer, 20(1), [504]. https://doi.org/10.1186/s12885-020-06975-2