ART Score and Predictive Factors of Prognosis in Hepatocellular Carcinoma Patients Treated With Transarterial Chemoembolization

Abstract

Introduction: Transarterial chemoembolization (TACE) with drug-eluting beads is the frontline treatment for BCLC intermediate-stage hepatocellular carcinoma (HCC). Recently, ART score was developed to assess prognosis after TACE. We aimed to evaluate the efficacy, safety, and predictive factors of prognosis in HCC patients treated with TACE in clinical practice. Methods: Retrospective evaluation of TACE procedures performed between June 2007 and October 2013 in a single center. Treatment decision was made based on multidisciplinary HCC consultation. Patient and tumor characteristics, response to treatment (mRECIST criteria, 1 month after TACE), adverse events, and ART score were evaluated. Kaplan-Meier was used for survival estimation, α=0.05. Results: Ninety-three procedures were performed in 55 patients (median age 71 years; 85% male; 98% cirrhosis), with median procedure per patient: 2. Viral hepatitis (51%) and alcohol (28%) were the main causes of liver disease. BCLC intermediate stage was more frequent (72%). The median admission duration was 2 days, postembolization syndrome developed in 15% without any fatalities. Response to treatment was complete in 23%, partial in 51%, stable disease in 13%, and progression in 14%. Patients with only 1 HCC nodule (OR=4.9; p=0.01) had a better response. Mean estimated survival after TACE was 28.8 months. A single HCC nodule (p=0.002), Child-Pugh A (p=0.014), HCC nodules <5 cm (p=0.024), BCLC stage (p=0.04), and α-fetoprotein <50 ng/mL (p=0.049) were predictive of survival. Response to TACE (p=0.001), the absence of post-embolization syndrome (p=0.002), and ART score <2 (p=0.005) were associated with longer survival. Conclusion: In our cohort, TACE was found to be safe and efficacious, as mRECIST response was associated with increased survival. We validated the prognostic importance of ART score and identified predictive factors of TACE response and survival that could improve the selection of treatment options for patients. Disclosure - Helder Cardoso - Advisory Committee: Janssen, Abbvie; Speaking and Teaching: BMS, Bayer, Roche.