A simple prognostic scoring system for patients receiving transarterial embolisation for hepatocellular cancer

Abstract

BackgroundThe prognosis for patients with hepatocellular cancer (HCC) undergoing transarterial therapy (TACE/TAE) is variable.MethodsWe carried out Cox regression analysis of prognostic factors using a training dataset of 114 patients treated with TACE/TAE. A simple prognostic score (PS) was developed, validated using an independent dataset of 167 patients and compared with Child–Pugh, CLIP, Okuda, Barcelona Clinic Liver Cancer (BCLC) and MELD.ResultsLow albumin, high bilirubin or α-fetoprotein (AFP) and large tumour size were associated with a two- to threefold increase in the risk of death. Patients were assigned one point if albumin <36 g/dl, bilirubin >17 μmol/l, AFP >400 ng/ml or size of dominant tumour >7 cm. The Hepatoma arterial-embolisation prognostic (HAP) score was calculated by summing these points. Patients were divided into four risk groups based on their HAP scores; HAP A, B, C and D (scores 0, 1, 2 and >2, respectively). The median survival for the groups A, B, C and D was 27.6, 18.5, 9.0 and 3.6 months, respectively. The HAP score validated well with the independent dataset and performed better than other scoring systems in differentiating high- and low-risk groups.ConclusionsThe HAP score predicts outcomes in patients with HCC undergoing TACE/TAE and may help guide treatment selection, allow stratification in clinical trials and facilitate meaningful comparisons across reported series.

Recommendations for the use of chemoembolization in patients with hepatocellular carcinoma: Usefulness of scoring system?

“…The HAP score divided the patients into three groups each with a different survival time (Table 1); median survival was the same for the HAP A and HAP B groups (31 mo). The patients in the HAP C and HAP D groups were considered to be poorer candidates for TACE and had a median survival of 22 mo and 18 mo, respectively, which is higher than the figures reported for the Kadalayil et al [48] cohort (9.0 mo and 3.6 mo, respectively Figure 5 Diagram to define untreatable tumor progression [29] . CR: Complete response; PR: Partial response; HCC: Hepatocellular carcinoma.…”

“…Several prognostic indices designed to help practitioners select appropriate candidates for an initial or repeat conventional TACE have been put forward in the past but none has been formally enshrined in the guidelines since they are difficult to implement or insufficiently discriminatory and are limited to conventional TACE [46,47] . The potentially useful staging systems published recently include: the hepatoma arterial-embolization prognostic (HAP) score published by Kadalayil et al [48] in 2013 which was also designed as an aid to selecting appropriate candidates for TACE. In this system, patients are awarded 1 point for each of the following four variables if present: albumin < 36 g/L, bilirubin > 17 mcmol/L, AFP > 400 ng/mL and tumour > 7 cm.…”

BCLC-B hepatocellular carcinoma treatment or when should the systemic therapy be started

“…Заслуживает внимания HAP-score: снижение уровня аль-бумина <36 г/л, повышение уровня общего билирубина > 17 мкмоль/л, АФП > 400 нг/мл и размера наибольшего узла свыше 7 см. Формируется сумма баллов: по 1 за каждый признак -0, 1, 2 и >2 баллов и, соответственно, группы А, В, С и D [19]. При этом медиана выживаемости после ТАХЭ в группах A, B, C, и D составила 27,6, 18,5, 9,0 и 3,6 месяца соответственно.…”

The problem of current classications of the hepatocellular carcinoma. Analytical review

“…Обе они разработаны на сериях около ста пациентов, под-вергшихся ТАХЭ, со стадиями А и В по BCLC (HAP, STATE) и стадией C (только HAP) [60,61]. Шкала NIACE на 321 па-циентах определила две группы с разной выживаемостью (NIACE ≤ 3:27мес.…”