Combined sequential use of HAP and ART scores to predict survival outcome and treatment failure following chemoembolization in hepatocellular carcinoma: a multi-center comparative study

Pinato, David J.; Arizumi, Tadaaki; Jang, Jeong Won; Allara, Elias; Suppiah, Puvan; Smirne, Carlo; Tait, Paul; Pai, Madhava; Grossi, G.; Kim, Young Woon; Pirisi, Mario; Kudo, Masatoshi; Sharma, Rohini

doi:10.18632/oncotarget.9604

Cited by 36 publications

(36 citation statements)

References 28 publications

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“…Interestingly, in an international study in 83 patients from the UK and Italy and 660 patients from Korea and Japan with HCC (BCLC stage A or B), both scoring systems were found to be independently predictive of survival, and sequential use of the HAP score to screen patients for initial TACE and the ART score to determine the value of TACE retreatment was proposed [62].…”

Section: Retreatmentmentioning

confidence: 99%

Patient Selection for Transarterial Chemoembolization in Hepatocellular Carcinoma: Importance of Benefit/Risk Assessment

2018

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Background: Liver cancer is the second most common cause of cancer-related death, with hepatocellular carcinoma (HCC) accounting for most primary liver cancers and most commonly arising from a history of advanced chronic liver disease. Among the available therapies, transarterial chemoembolization (TACE) is the most widely utilized and is considered the first-line treatment recommended for patients staged as intermediate HCC (Barcelona Clinic Liver Cancer stage B). If applied correctly, TACE can produce survival benefits without adversely affecting hepatic functional reserve. Summary: The aim of this nonsystematic review is to evaluate the evidence supporting TACE, with a special interest in intermediate HCC, for which this treatment is recommended in first line. However, intermediate HCC represents a broad and heterogeneous group of patients, not all of whom will benefit from TACE. This review highlights the importance of appropriate patient selection for initial TACE and for retreatment. It also evaluates evidence for the treatment of patients who become refractory to TACE. Some patients may, in fact, benefit from early switch (i.e., after 1 or 2 TACE treatments) to systemic therapies rather than continuing retreatments with TACE in order to preserve liver function, thus allowing sequential first- and second-line drug therapies. Key Messages: Careful assessment of an individual patient's benefit/risk ratio is recommended before any TACE session is considered to ensure optimal long-term outcomes in intermediate HCC.

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Section: Retreatmentmentioning

confidence: 99%

Patient Selection for Transarterial Chemoembolization in Hepatocellular Carcinoma: Importance of Benefit/Risk Assessment

2018

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“…Nevertheless, none of the scores reached an AUC of more than 70%, which is why a further evaluation or modification of the scores is needed concerning the mentioned endpoint to support clinical decision making. All the mentioned four scores were validated in various studies, but mainly regarding to the endpoint of median OS (Allgaier et al 1998;Dhanasekaran et al 2010;Farinati et al 2000;Georgiades et al 2006;Kadalayil et al 2013;op den Winkel et al 2012;Pinato et al 2016;Rabe et al 2003). We recommend that scores should be evaluated concerning further endpoints additional to the endpoint of OS.…”

Section: Discussionmentioning

confidence: 99%

Applicability of scoring systems predicting outcome of transarterial chemoembolization for hepatocellular carcinoma

Vogeler

Mohr

Pfeiffenberger

et al. 2020

J Cancer Res Clin Oncol

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Purpose Several scoring systems have been proposed to predict the outcome of transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). However, the application of these scores to a bridging to transplant setting is poorly validated. Evaluation of the applicability of prognostic scores for patients undergoing TACE in palliative intention vs. bridging therapy to liver transplantation (LT) is necessary. Methods Between 2008 and 2017, 148 patients with HCC received 492 completed TACE procedures (158 for bridging to transplant; 334 TACE procedures in palliative treatment intention at our center and were analyzed retrospectively. Scores (ART, CLIP, ALBI, APRI, SNACOR, HAP, STATE score, Child-Pugh, MELD, Okuda and BCLC) were calculated and evaluated for prediction of overall survival. ROC analysis was performed to assess prediction of 3-year survival and treatment discontinuation. Results In patients receiving TACE in palliative intention most scores predicted OS in univariate analysis but only mSNA-COR score (p = 0.006), State score (p < 0.001) and Child-Pugh score (p < 0.001) revealed statistical significance in the multivariate analysis. In the bridging to LT cohort only the BCLC score revealed statistical significance (p = 0.002). Conclusions Clinical usability of suggested scoring systems for TACE might be limited depending on the individual patient cohorts and the indication. Especially in patients receiving TACE as bridging to LT none of the scores showed sufficiently applicability. In our study Child-Pugh score, STATE score and mSNACOR score showed the best performance assessing OS in patients with TACE as palliative therapy.

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“…With the ALBI grade confirming its clinical utility across an increasing proportion of patient subgroups, a further point that has so far been left unaddressed in the prognostic qualification of the ALBI grade is its potential to reflect dynamic changes in the functional reserve of patients with HCC. There is an accumulating body of evidence that suggests worsening Child-Pugh scores to be a strong adverse prognostic determinant following loco-regional treatment of HCC [9][10][11], as well as during treatment with sorafenib [11]. In a previous study, we showed that improvement of albumin levels after chemo-embolisation through suppression of the cancer-related pro-inflammatory response predicts for better outcomes in patients with intermediate-stage HCC [12].…”

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confidence: 86%

Reply to: ‘Validating the ALBI grade: Its current and future use in HCC prognostication’

Pinato

Yen

Sharma

2017

Journal of Hepatology

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We thank Chan et al. for their kind comments outlined in their Letter to the Editor. A number of points are also highlighted for discussion pertaining to our manuscript ''The ALBI grade provides objective hepatic reserve estimation across each BCLC stage of hepatocellular carcinoma" [1].The evolving precision in the diagnosis and management of hepatocellular carcinoma (HCC) has led, over the past decades, to a progressive improvement in treatment allocation, such that an increasing proportion of patients are now being considered for a range of effective treatments with proven survival benefit over best supportive care [2].With this notion in mind and given the geographical and temporal heterogeneity of our study population, we evaluated whether the prognostic ability of the ALBI grade might have been influenced by a cohort effect relating to the time of diagnosis (pre-or post-year 2000). This was of particular importance in our study, given the high proportion of patients treated with loco-regional therapies (n = 1461), a patient subpopulation with notorious diversity in survival outcomes [3].The improved discriminatory ability of the ALBI grade over time, that has now also been independently observed by Chan et al., is somehow thought provoking in the biological qualification of the ALBI grade as a novel biomarker of liver functional reserve. Although emerging from retrospective studies, the mutual relationship between ALBI grade, antiviral treatment and survival highlighted by Chan et al. strongly resonates with level I evidence suggesting disease-modulating effects of nucleot(s)ide analogues following curative therapy of hepatitis B virus (HBV)-related HCC [4], where optimal control of viral replication seems more important in influencing survival than systemic anti-cancer control with adjuvant sorafenib therapy [5].With the discriminative ability of the ALBI being highest in patients classifying within Child-Pugh A criteria [6] it is perhaps unsurprising that the wider adoption of anti-HBV treatment over time in patients with HCC might have led to improved hepatic functional reserve and therefore better survival outcomes, reflected by the superior predictive accuracy of the ALBI grade.Over time, the availability and efficacy of treatment for hepatitis C virus (HCV) has also changed significantly, and the effect of antiviral therapy on patients' survival and discriminatory ability of the ALBI grade might extend to HCV-related chronic liver disease where highly active interferon-free regimens currently produce sustained virological responses in >95% of the patients treated with direct-acting antiviral agents [7].In answer to the second point raised by Chan et al., we tested whether the ALBI grade maintained its prognostic accuracy in a subset of 269 patients with HCC and without cirrhosis derived from our dataset. In this subgroup, Child-Pugh score was A5 in 144 (54%), A6 in 108 (40%) and B7 in 17 (6%). In non-cirrhotic patients with HCC, median overall survival (OS) was 19.7 months (95% CI 14.9-24.4) for ALBI ...

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Combined sequential use of HAP and ART scores to predict survival outcome and treatment failure following chemoembolization in hepatocellular carcinoma: a multi-center comparative study

Cited by 36 publications

References 28 publications

Patient Selection for Transarterial Chemoembolization in Hepatocellular Carcinoma: Importance of Benefit/Risk Assessment

Patient Selection for Transarterial Chemoembolization in Hepatocellular Carcinoma: Importance of Benefit/Risk Assessment

Applicability of scoring systems predicting outcome of transarterial chemoembolization for hepatocellular carcinoma

Reply to: ‘Validating the ALBI grade: Its current and future use in HCC prognostication’

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