TY - JOUR
T1 - The munich-transarterial chemoembolisation score holds superior prognostic capacities compared to TACE-tailored modifications of 9 established staging systems for hepatocellular carcinoma
AU - Op Den Winkel, Mark
AU - Nagel, Dorothea
AU - Op Den Winkel, Philip
AU - Paprottka, Philipp M.
AU - Schmidt, Laura
AU - Bourhis, Hélène
AU - Trojan, Jörg
AU - Goeller, Markus
AU - Reiter, Florian P.
AU - Stecher, Stephanie Susanne
AU - De Toni, Enrico N.
AU - Gerbes, Alexander L.
AU - Kolligs, Frank T.
N1 - Publisher Copyright:
© 2018 S. Karger AG, Basel.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - Background/Aims: The recently proposed Munich-transarterial chemoembolisation-score (M-TACE) was tailored to suit hepatocellular Carcinoma (HCC) patients evaluated for TACE. M-TACE outperformed the established HCC-staging-systems and successfully passed external validation. Modifications of staging-systems through the rearrangement of stages or by adding prognostic factors are methods of improving prognostic power. M-TACEs performance compared to scores modified this way should be tested. Methods: Seven well-known HCC staging-systems (including Cancer of the Liver Italian Program-score [CLIP] and Barcelona Clinic liver cancer [BCLC]) and 2 TACE-specific scores (Selection for Transarterial Chemoembolisation Treatment [STATE] and Hepatoma Arterial embolisation Prognostic [HAP]) were rearranged in a cohort of 186 TACE-patients through score-point-analysis and subsequent linking of non-significant adjacent score-points. Additionally, a new score was constructed by combining the top established staging-system in TACE patients (CLIP-TACE) and the prognostic parameter with the highest hazard ratio for death in the TACE-cohort [C-reactive protein (CRP)]. Additionally, the TACE-tailored-scores were applied to an external TACE-cohort (n = 71). -Results: Rearrangement resulted in optimal stratification and monotonicity. CLIP-TACE demonstrated the best prognostic capability of all rearranged scores (c-index 0.668, AIC 1294) and the addition of CRP yielded further prognostic improvement (c-index 0.680, AIC 1289). However, superiority over M-TACE could not be achieved by any of the new scores in the internal and external cohort. Conclusion: M-TACE outperforms TACE-tailored modifications of all relevant HCC-staging-systems. Prospective validation of M-TACE to promote its role as the preferred staging-system for TACE-patients is therefore justified.
AB - Background/Aims: The recently proposed Munich-transarterial chemoembolisation-score (M-TACE) was tailored to suit hepatocellular Carcinoma (HCC) patients evaluated for TACE. M-TACE outperformed the established HCC-staging-systems and successfully passed external validation. Modifications of staging-systems through the rearrangement of stages or by adding prognostic factors are methods of improving prognostic power. M-TACEs performance compared to scores modified this way should be tested. Methods: Seven well-known HCC staging-systems (including Cancer of the Liver Italian Program-score [CLIP] and Barcelona Clinic liver cancer [BCLC]) and 2 TACE-specific scores (Selection for Transarterial Chemoembolisation Treatment [STATE] and Hepatoma Arterial embolisation Prognostic [HAP]) were rearranged in a cohort of 186 TACE-patients through score-point-analysis and subsequent linking of non-significant adjacent score-points. Additionally, a new score was constructed by combining the top established staging-system in TACE patients (CLIP-TACE) and the prognostic parameter with the highest hazard ratio for death in the TACE-cohort [C-reactive protein (CRP)]. Additionally, the TACE-tailored-scores were applied to an external TACE-cohort (n = 71). -Results: Rearrangement resulted in optimal stratification and monotonicity. CLIP-TACE demonstrated the best prognostic capability of all rearranged scores (c-index 0.668, AIC 1294) and the addition of CRP yielded further prognostic improvement (c-index 0.680, AIC 1289). However, superiority over M-TACE could not be achieved by any of the new scores in the internal and external cohort. Conclusion: M-TACE outperforms TACE-tailored modifications of all relevant HCC-staging-systems. Prospective validation of M-TACE to promote its role as the preferred staging-system for TACE-patients is therefore justified.
KW - Barcelona clinic liver cancer
KW - Cancer of the liver Italian programme-score
KW - Hepatocellular carcinoma staging systems
KW - Hepatoma arterial embolisation prognostic
KW - Munich-transarterial chemoembolisation-score
KW - Selection for transarterial chemoembolisation treatment
UR - http://www.scopus.com/inward/record.url?scp=85054573018&partnerID=8YFLogxK
U2 - 10.1159/000493136
DO - 10.1159/000493136
M3 - Article
C2 - 30282074
AN - SCOPUS:85054573018
SN - 0012-2823
VL - 100
SP - 15
EP - 26
JO - Digestion
JF - Digestion
IS - 1
ER -
