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

  • 주제(키워드) Hepatocellular carcinoma , Transarterial chemoembolization , Child-Pugh classification , Risk prediction model
  • 주제(기타) Oncology
  • 설명문(일반) [Nam, Joon Yeul; Choe, A. Reum; Kim, Hwi Young; Kim, Tae Hun; Yoo, Kwon] Ewha Womans Univ, Coll Med, Dept Internal Med, 1071 Anyangcheon Ro, Seoul 07985, South Korea; [Nam, Joon Yeul; Lee, Jeong-Hoon; Yu, Su Jong; Kim, Yoon Jun; Yoon, Jung-Hwan] Seoul Natl Univ, Coll Med, Dept Internal Med, 101 Daehak Ro, Seoul 03080, South Korea; [Nam, Joon Yeul; Lee, Jeong-Hoon; Yu, Su Jong; Kim, Yoon Jun; Yoon, Jung-Hwan] Seoul Natl Univ, Coll Med, Liver Res Inst, 101 Daehak Ro, Seoul 03080, South Korea; [Sinn, Dong Hyun] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Dept Internal Med, Seoul, South Korea; [Lee, Jeong Min; Chung, Jin Wook] Seoul Natl Univ, Dept Radiol, Coll Med, Seoul, South Korea; [Choi, Sun Young; Lee, Jeong Kyong; Baek, Seung Yon] Ewha Womans Univ, Coll Med, Dept Radiol, Seoul, South Korea; [Lee, Hye Ah] Ewha Womans Univ, Clin Trial Ctr, Mokdong Hosp, Seoul, South Korea
  • 등재 SCIE, SCOPUS
  • OA유형 Green Published, gold
  • 발행기관 BMC
  • 발행년도 2020
  • 총서유형 Journal
  • URI http://www.dcollection.net/handler/ewha/000000169266
  • 본문언어 영어
  • Published As https://dx.doi.org/10.1186/s12885-020-06975-2
  • PubMed https://pubmed.ncbi.nlm.nih.gov/32487089

초록/요약

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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