Abstract
PurposeSeveral 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.MethodsBetween 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.ResultsIn patients receiving TACE in palliative intention most scores predicted OS in univariate analysis but only mSNACOR 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).ConclusionsClinical 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.
Highlights
Therapeutic approaches to hepatocellular carcinoma (HCC) are multimodal
The ROC analysis of the database in our study showed that none of the 13 scores had an AUC of over 70% some of the scores reached significance in the analysis concerning the probability of achieving a 3-years survival such, e.g., Cancer of the Liver Italian Program (CLIP), Okuda, HAP- and Child–Pugh score
The analysis showed a certain applicability of the Child–Pugh, Okuda, HAP and CLIP score for the assessment of the probability of achieving a 3-years survival after TACE procedure
Summary
Therapeutic approaches to hepatocellular carcinoma (HCC) are multimodal. Management and prognosis of HCC patients highly depends on tumor status, general health and actual liver functional reserve (Cabibbo et al 2010; Llovet et al 1999b; Marrero et al 2005; Okuda et al 1985). Various scoring systems (Table 1) predicting the prognosis of HCC patients undergoing different therapies are available (Ho et al 2017; Hucke et al 2014a, b; Kadalayil et al 2013; Kamath et al 2001; Kim et al 2016; Li et al 2016; Marrero et al 2005; Cancer of the Liver Italian Program (CLIP) Investigators 1998; Okuda et al 1985; Sawhney et al 2011; Song et al 2016; Yin et al 2016), to guide treatment decisions, like e.g., the commonly used BCLC classification (Cillo et al 2006; Guglielmi et al 2008; Llovet et al 1999a, 2008,2012; Marrero et al 2005; Vitale et al 2009).
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
