Division of Gastroenterology and Hepatology, Department of Internal Medicine III, AKH & Medical University of Vienna, Austria.
Background: We aimed to establish an objective point score to guide the decision for retreatment with transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC).
Methods: 222 patients diagnosed with HCC and treated with multiple TACE cycles between 1/1999 and 12/2009 at the Departments of Gastroenterology/Hepatology of the Medical Universities of Vienna (training cohort) and Innsbruck (validation cohort) were included. We investigated the effect of the first TACE on parameters of liver function and tumor response and their impact on overall survival (OS, log rank test) and developed a point score (ART-score: Assessment for Retreatment with TACE) in the training cohort (n=107, Vienna) by using a stepwise Cox regression model. The ART-score was externally validated in an independent validation cohort (n=115, Innsbruck).
Results: The increase of AST by >25% (Hazard Ratio (HR) 8.4; p<0.001), the increase of Child-Pugh score of one (HR 2.0) or ≥2 points (HR 4.4) (p<0.001) from baseline and absence of radiologic tumor response (HR 1.7; p=0.026) remained independent negative prognostic factors for OS and were used to create the ART-score. The ART-score differentiated 2 groups (0-1.5 points; ≥2.5 points) with distinct prognosis (median OS: 23.7 vs. 6.6 months; p<0.001) and a higher ART-score was associated with major adverse events after the second TACE (p=0.011). These results were confirmed in the external validation cohort and remained significant irrespective of Child-Pugh stage and the presence of ascites prior the second TACE.
Conclusion: An ART-score of ≥2.5 prior the second TACE identifies patients with dismal prognosis who may not profit from further TACE sessions.