Evaluation of ART Scores for Repeated Transarterial Chemoembolization in Japanese Patients with Hepatocellular Carcinoma

Abstract

Objective: Transarterial chemoembolization (TACE) is recommended as a first-line therapy for hepatocellular carcinoma (HCC) patients ineligible for curative therapy and without portal invasion. The Assessment for Retreatment with TACE (ART) scoring system was recently proposed for identifying patients who would not show sufficient survival benefit from repeated TACE. We reevaluated the performance of ART in HCC patients treated in Japan, where selective TACE is commonly used. Methods: Between 2000 and 2013, 988 patients with HCC underwent TACE at Kinki University Hospital, and 627 received ≥2 sessions of TACE. Seventy-six patients who underwent ≥2 TACE sessions within 90 days were investigated for their performance of the ART score in the context of overall survival (OS). Results: Only 12% (76/627) of patients underwent ≥2 TACE sessions within 90 days. Of those, 52 patients showed a low ART score (0-1.5), and 24 had a high ART score (≥2.5); the median OS was 20.2 and 37.6 months, respectively (p = 0.8207). Conclusion: The ART scoring system did not demonstrate a sufficiently predictive impact on OS among the patients who underwent ≥2 TACE sessions within 90 days. Application of the ART score should be carefully considered because differences in TACE procedures and post-TACE treatment can affect the results while evaluating OS.

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

“…Furthermore, in a retrospective analysis of 627 Japanese patients with HCC (most with Child-Pugh A and BCLC stage B) who had received 2 or more TACE sessions, the ART score was found to be unsuitable for most patients, as only 12% had received their second TACE within 90 days. For these patients, the ART score did not predict overall survival [47]. This finding was also reported in a smaller Japanese retrospective study, where less than 10% of patients had their second TACE session within 90 days of the first, and the ART score did not predict outcomes in these patients [60].…”

“…Intermediate-stage HCC patients present with varying tumor burdens, liver function, and disease etiology, and some patients may benefit from alternative treatment options [42]. An overview of the key factors for patient selection in TACE is shown in Figure 1 [3,27,34,[43][44][45][46][47].…”

“…The generated CHIP scores were then differentiated into 5 groups (0-2, 3, 4, 5, and 6-7 points) by median survival times (65.2, 29.2, 24.3, 13.1, and 8.4 months). This Candidates for surgical/ablation therapies Reference materials • BCLC staging system [3] • JSH guideline [27] • HKLC staging system [34] Yes Previous treatment TACE-naïve Assessment of outcome from previous TACE Candidates for TACE Candidates for repeat TACE Reference materials • ART score [46,47] • Definition of refractory TACE (JSH) [27] • Preposed treatment algorithm for repetition of conventional TACE [43] Predict effectiveness and risk Reference materials • HAP score [44] • CHIP score, etc. approach could be used on a larger scale to stratify responders in more detail from randomized controlled trials and simplify the scoring approach.…”

“…This decision may be guided by retreatment algorithms, such as the Assessment for Retreatment with TACE (ART) [46,47], and the α-fetoprotein, BCLC, Child-Pugh and Response (ABCR) [58] scores (Fig. 1).…”

Evidence and Consensus on the Management of Hepatocellular Carcinoma: Update 2015

“…Arizumi et al [1] stated that the Assessment for Retreatment with Transarterial Chemoembolization (TACE) [2,3,4] (ART) scoring system, which was proposed by Sieghart et al [5], did not demonstrate a sufficiently predictive impact on overall survival among patients who underwent a 2nd TACE session within 90 days [6]. Also, they stated that the application of the ART score should be carefully considered because differences in TACE procedures and post-TACE treatment can affect the results while evaluating overall survival.…”