TY - JOUR
T1 - Transarterial chemoembolization for hepatocellular carcinoma
T2 - Development and external validation of the Munich-TACE score
AU - Den Winkel, Mark Op
AU - Nagel, Dorothea
AU - Den Winkel, Philip Op
AU - Trojan, Jörg
AU - Paprottka, Philipp M.
AU - Steib, Christian J.
AU - Schmidt, Laura
AU - Göller, Markus
AU - Stieber, Petra
AU - Göhring, Peter
AU - Herbst, Andreas
AU - Rentsch, Markus
AU - De Toni, Enrico N.
AU - Göke, Burkhard
AU - Gerbes, Alexander L.
AU - Kolligs, Frank T.
N1 - Publisher Copyright:
© 2017 Wolters Kluwer Health, Inc.
PY - 2018/1
Y1 - 2018/1
N2 - Background Allocation of patients with hepatocellular carcinoma (HCC) to the adequate therapy is determined by both tumor burden and liver function. The Barcelona Clinic Liver Cancer (BCLC) staging system and therapeutic algorithm recommends transarterial chemoembolization (TACE) based on the best evidence available to patients with intermediate-stage HCC (BCLC-B). However, many centers also treat subgroups of patients outside these recommendations and with more advanced disease by TACE. The purpose of this study was to identify prognostic factors in a TACE cohort, including BCLC-B patients, as well as patients treated outside of BCLC-B, to test the prognostic capabilities of published staging systems and to optimize prognostication for TACE patients. Patients and methods A cohort of 186 first-line TACE patients was analyzed. Independent prognostic factors were identified and used to construct the Munich-TACE score (M-TACE). M-TACE was tested against established staging systems (including BCLC and two recently published TACE-specific scores) and a ranking using concordance index and Akaike Information Criterion was performed. Finally, an external validation in an independent TACE cohort (n=71) was conducted. Results Bilirubin, Quick/international normalized ratio, C-reactive protein, creatinine, α-feto protein, and tumor extension were identified as independent prognostic factors and used to construct M-TACE. M-TACE identifies three distinct subgroups (P<0.0001) with median survival times of 35.2, 16.9, and 8.6 months, respectively. Compared with established staging systems, M-TACE showed the best prognostic capabilities in both cohorts of patients (cohort 1: C-index, 0.71; Akaike Information Criterion: 1276; cohort 2: C-index, 0.754). Conclusion We identified independent risk factors for patients treated with TACE. The newly constructed M-TACE score is superior to established staging systems and might prove helpful to identify patients who are most suitable for TACE.
AB - Background Allocation of patients with hepatocellular carcinoma (HCC) to the adequate therapy is determined by both tumor burden and liver function. The Barcelona Clinic Liver Cancer (BCLC) staging system and therapeutic algorithm recommends transarterial chemoembolization (TACE) based on the best evidence available to patients with intermediate-stage HCC (BCLC-B). However, many centers also treat subgroups of patients outside these recommendations and with more advanced disease by TACE. The purpose of this study was to identify prognostic factors in a TACE cohort, including BCLC-B patients, as well as patients treated outside of BCLC-B, to test the prognostic capabilities of published staging systems and to optimize prognostication for TACE patients. Patients and methods A cohort of 186 first-line TACE patients was analyzed. Independent prognostic factors were identified and used to construct the Munich-TACE score (M-TACE). M-TACE was tested against established staging systems (including BCLC and two recently published TACE-specific scores) and a ranking using concordance index and Akaike Information Criterion was performed. Finally, an external validation in an independent TACE cohort (n=71) was conducted. Results Bilirubin, Quick/international normalized ratio, C-reactive protein, creatinine, α-feto protein, and tumor extension were identified as independent prognostic factors and used to construct M-TACE. M-TACE identifies three distinct subgroups (P<0.0001) with median survival times of 35.2, 16.9, and 8.6 months, respectively. Compared with established staging systems, M-TACE showed the best prognostic capabilities in both cohorts of patients (cohort 1: C-index, 0.71; Akaike Information Criterion: 1276; cohort 2: C-index, 0.754). Conclusion We identified independent risk factors for patients treated with TACE. The newly constructed M-TACE score is superior to established staging systems and might prove helpful to identify patients who are most suitable for TACE.
KW - Barcelona Clinic Liver Cancer
KW - Cancer of the Liver Italian Program
KW - Hepatocellular carcinoma staging systems
KW - Hepatoma Arterial embolization Prognostic
KW - Selection for Transarterial Chemoembolization Treatment
UR - http://www.scopus.com/inward/record.url?scp=85047779224&partnerID=8YFLogxK
U2 - 10.1097/MEG.0000000000001005
DO - 10.1097/MEG.0000000000001005
M3 - Article
C2 - 29076939
AN - SCOPUS:85047779224
SN - 0954-691X
VL - 30
SP - 44
EP - 53
JO - European Journal of Gastroenterology and Hepatology
JF - European Journal of Gastroenterology and Hepatology
IS - 1
ER -
