The ART-strategy: Sequential assessment of the ART-score predicts outcome of patients with hepatocellular carcinoma re-treated with TACE

Addition of tumor multiplicity improves the prognostic performance of the hepatoma arterial‐embolization prognostic score

“…Although a recent study showed that development of progression or need for three sessions of TACE within the first 6 months is predictive of TACE refractoriness , early optimization in the treatment strategy even at baseline or after the first TACE using the SNACOR and ART scores as well as our mHAP‐II is warranted, rather than adhering to repeated TACEs until disease progression is identified . Furthermore, because suboptimal or incomplete TACE can be subject to the abrupt dissemination of HCC , early decision making for the treatment strategy can be considered.…”

Risk prediction for patients with hepatocellular carcinoma undergoing chemoembolization: development of a prediction model

“… developed the ART score (assessment for re‐treatment with TACE), which integrated radiological tumour response and impairment of liver function and Hucke et al . showed the prognostic usefulness of the sequential assessment of the ART score for HCC treated with repeated TACE sessions by monitoring dynamics in tumour‐related factors and liver function after each TACE session. Although the ART score is a model to predict survival outcomes through assessment of probability of liver function deterioration as well as on‐treatment response, our score is based on a comprehensive assessment of tumour factors, underlying liver function and on‐treatment response.…”

Review article: delivering precision oncology in intermediate‐stage liver cancer

“…Increasing research efforts have been dedicated to the identification of optimal stratifying characteristics in TACE candidates, with the intended benefit to identify patients whose survival gain following initial TACE is anticipated to be very small and migrate them to alternative, more efficacious treatments . Some of these models are devised to provide clinicians with objective re‐treatment criteria based on dynamic changes of clinical and radiological parameters following initial treatment, with the intent to spare repeat embolisation for those patients displaying deteriorating scores for whom further treatment may be more harmful …”

“…Following on from the initial experience, in a separate study consisting of a pooled analysis of 109 patients derived from the same two retrospective cohorts, Hucke et al. Explored the prognostic utility of the sequential use of the ART score in patients undergoing multiple TACE sessions . The re‐assessment of ART in patients undergoing second (n=109), third (n=77) and fourth TACE (n=29) showed adequate prognostic sub‐classification at each time point despite the decreasing number of analysed patients, allowing the investigators to conclude that worsening of the ART score to >2.5 at any stage of the sequential loco‐regional retreatment of HCC is harbinger of a poorer prognosis and should preclude further TACE.…”

“…While of potential clinical value in optimising treatment outcomes, a comprehensive evaluation of the START strategy has not been performed externally, and the series of studies conducted in the same Austrian patient cohorts, which were collected retrospectively and across a wide time window might have led to over‐fitting of the prognostic models due to differing disease severity, treatment pathways as well as missing data …”