Transarterial chemoembolization for hepatocellular carcinoma: development and external validation of the Munich-TACE score

Winkel, Mark op den; Nagel, Dorothea; Winkel, P op den; Trojan, Jörg; Paprottka, Philipp M.; Steib, Christian; Schmidt, Laura S.; Göller, M.; Stieber, P.; Göhring, Peter; Herbst, Andreas; Rentsch, Markus; Toni, Enrico N. De; Göke, Burkhard; Gerbes, Alexander L.; Kolligs, Frank T.

doi:10.1097/meg.0000000000001005

Cited by 11 publications

(11 citation statements)

References 32 publications

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“…When considering TACE as a treatment option, scoring systems could be of help in the decision-making process [54,55,56]. Although these scoring systems may not be validated for similar treatment strategies, the best fit patients for trans-arterial radio- or chemoembolization are the ones with preserved liver function as well [47].…”

Section: Overview On the Current State Of Liver Directed Therapy Smentioning

confidence: 99%

Current State of Liver-Directed Therapies and Combinatory Approaches with Systemic Therapy in Hepatocellular Carcinoma (HCC)

Viveiros

Riaz

Lewandowski

et al. 2019

Cancers

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The increasing set of liver-directed therapies (LDT) have become an integral part of hepatocellular carcinoma (HCC) treatment. These range from percutaneous ablative techniques to arterial embolization, and varied radiotherapy strategies. They are now used for local disease control, symptom palliation, and bold curative strategies. The big challenge in the face of these innovative and sometimes overlapping technologies is to identify the best opportunity of use. In real practice, many patients may take benefit from LDT used as a bridge to curative treatment such as resection and liver transplantation. Varying trans-arterial embolization strategies are used, and comparison between established and developing technologies is scarce. Also, radioembolization utilizing yttrium-90 (Y-90) for locally advanced or intermediate-stage HCC needs further evidence of clinical efficacy. There is increasing interest on LDT-led changes in tumor biology that could have implications in systemic therapy efficacy. Foremost, additional to its apoptotic and necrotic properties, LDT could warrant changes in vascular endothelial growth factor (VEGF) expression and release. However, trans-arterial chemoembolization (TACE) used alongside tyrosine-kinase inhibitor (TKI) sorafenib has had its efficacy contested. Most recently, interest in associating Y-90 and TKI has emerged. Furthermore, LDT-led differences in tumor immune microenvironment and immune cell infiltration could be an opportunity to enhance immunotherapy efficacy for HCC patients. Early attempts to coordinate LDT and immunotherapy are being made. We here review LDT techniques exposing current evidence to understand its extant reach and future applications alongside systemic therapy development for HCC.

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Section: Overview On the Current State Of Liver Directed Therapy Smentioning

confidence: 99%

Current State of Liver-Directed Therapies and Combinatory Approaches with Systemic Therapy in Hepatocellular Carcinoma (HCC)

Viveiros

Riaz

Lewandowski

et al. 2019

Cancers

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“…In particular, the BCLC staging system represents the most commonly used score in Western countries to predict prognosis and guide treatments. However, two different studies showed that the prognostic value of BCLC was limited in the setting of TACE [ 24 , 25 ].…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, a multitude of TACE-specific staging systems have been developed, such as the hepatoma arterial embolization prognostic (HAP) score [ 26 ], the selection for transarterial chemoembolization treatment (STATE) score [ 27 ], the Munich-transarterial chemoembolization score (M-TACE) [ 25 ], the six-and-twelve score [ 28 ], and the albumin–bilirubin (ALBI) grade [ 29 ]. These prognostic scores are based on prediction factors collected before the cTACE procedure, such as tumor characteristics (e.g., tumor size, vascular invasion), hepatic function (e.g., albumin, bilirubin blood levels), blood markers such as alpha-fetoprotein (AFP), and chronic liver severity indexes such as the Child–Pugh score [ 30 , 31 ].…”

Section: Introductionmentioning

confidence: 99%

TRANS-TACE: Prognostic Role of the Transient Hypertransaminasemia after Conventional Chemoembolization for Hepatocellular Carcinoma

Granito

Facciorusso

Sacco

et al. 2021

JPM

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The aim of the present study was to correlate laboratory data and postprocedural parameters after conventional transarterial chemoembolization (cTACE) for hepatocellular carcinoma (HCC) with the radiological response. The study consisted of a retrospective analysis of prospectively collected data from 70 consecutive patients who underwent cTACE. Laboratory parameters were assessed daily after cTACE and compared to pretreatment values. Post-treatment radiological response was assessed using mRECIST at one month from cTACE, and factors associated with treatment response (complete and objective response) were assessed by logistic regression analysis. The optimal cutoff points in predicting the complete response of target lesions were a 52% ALT and a 46% AST increase after cTACE compared to the pre-treatment values. Using multivariate analyses, >46% AST and >52% ALT increases with respect to the pre-treatment value were significantly correlated with the objective response (p = 0.03 and p = 0.04, respectively) and the complete response (p = 0.02 and p = 0.02, respectively). No patients experienced liver function deterioration after cTACE, and no specific treatment was required. This study showed that post-treatment transient transaminase elevation was predictive of objective response to superselective cTACE in clinical practice, representing a simple tool to guide treatment strategy of HCC patients in a tailored approach.

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“…Three unidimensional classifications were tested: TNM [25], Child-Pugh score [26], and ALBI-grade [27]. Additionally, a recently published TACE-specific score (M-TACE) [28] was applied.…”

Section: Tested Staging Systemsmentioning

confidence: 99%

Development and External Validation of the Munich Sorafenib Evaluation Score for Hepatocellular Carcinoma

Winkel

Nagel

Seidensticker

et al. 2022

Dig Dis

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Introduction: In recent years increasing options for systemic HCC treatment have become available. The development of therapy-specific prognostic scores has been encouraged. Tailoring therapy to individual patients requires prognostic scores for treatment success in addition to the Barcelona-Clinic-Liver-Cancer (BCLC) classification. We have developed and validated a prognostic score for patients treated with sorafenib. Methods: Prognostic factors identified in a multivariate analysis of 108 sorafenib patients were used to construct the Munich-Sorafenib-Evaluation score (M-SE). M-SE and 9 established HCC prognostic systems were ranked according to concordance-index and AIC. External M-SE-validation was performed in an independent HCC sorafenib cohort (n=101) derived from the prospective multicentre randomized controlled SORAMIC trial. Results: Ascites (p<0.0001; HR 2.923), tumor burden ≥50% of the liver (p=0.0033; HR 1.946) and GOT (p<0.0001; HR 1.716) were identified as independent prognostic parameters. All three M-SE stages were characterized by significantly different survival times (p<0.0001). M-SE stage A patients had a median OS of 18.7 months (95% CI 15.6-21.8), patients in stage B and C showed a significantly shorter survival of 5.7 (2.7-8.7) and 2.0 months (1.6-2.4), respectively. M-SE (c-index 0.70; AIC 621) outperformed all other prognostic systems. External validation in a prospective cohort confirmed its superior prognostic performance. Conclusion: The M-SE score allows classification of sorafenib-patients in three distinct prognostic stages. Provided that M-SE successfully passes prospective validation, it can help to predict the outcome of patients evaluated for sorafenib treatment.

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Transarterial chemoembolization for hepatocellular carcinoma: development and external validation of the Munich-TACE score

Abstract: 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.

Cited by 11 publications

References 32 publications

Current State of Liver-Directed Therapies and Combinatory Approaches with Systemic Therapy in Hepatocellular Carcinoma (HCC)

Current State of Liver-Directed Therapies and Combinatory Approaches with Systemic Therapy in Hepatocellular Carcinoma (HCC)

TRANS-TACE: Prognostic Role of the Transient Hypertransaminasemia after Conventional Chemoembolization for Hepatocellular Carcinoma

Development and External Validation of the Munich Sorafenib Evaluation Score for Hepatocellular Carcinoma

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