Tumor Burden in Patients With Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization: Head-to-Head Comparison of Current Scoring Systems

Lukas Müller,De-Hua Chang,Uli Fehrenbach,Daniel Pinto Dos Santos,Roman Kloeckner,Sebastian Zensen,Moon-Sung Kim,Michel Eisenblätter,Thierno D Diallo,David Zopfs,Dominik Bettinger,Bernhard Gebauer,Timo Alexander Auer,Verena Steinle,Johannes Haubold,Felix Hahn

doi:10.3389/fonc.2022.850454

Abstract

ObjectivesRecently, several scoring systems for prognosis prediction based on tumor burden have been promoted for patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). This multicenter study aimed to perform the first head-to-head comparison of three scoring systems.MethodsWe retrospectively enrolled 849 treatment-naïve patients with HCC undergoing TACE at six tertiary care centers between 2010 and 2020. The tumor burden score (TBS), the Six-and-Twelve score (SAT), and the Seven-Eleven criteria (SEC) were calculated based on the maximum lesion size and the number of tumor nodes. All scores were compared in univariate and multivariate regression analyses, adjusted for established risk factors.ResultsThe median overall survival (OS) times were 33.0, 18.3, and 12.8 months for patients with low, medium, and high TBS, respectively (p<0.001). The median OS times were 30.0, 16.9, and 10.2 months for patients with low, medium, and high SAT, respectively (p<0.001). The median OS times were 27.0, 16.7, and 10.5 for patients with low, medium, and high SEC, respectively (p<0.001). In a multivariate analysis, only the SAT remained an independent prognostic factor. The C-Indexes were 0.54 for the TBS, 0.59 for the SAT, and 0.58 for the SEC.ConclusionIn a direct head-to-head comparison, the SAT was superior to the TBS and SEC in survival stratification and predictive ability. Therefore, the SAT can be considered when estimating the tumor burden. However, all three scores showed only moderate predictive power. Therefore, tumor burden should only be one component among many in treatment decision making.

Highlights

Hepatocellular carcinoma (HCC) is the fifth most common cancer entity worldwide and is responsible for the second-highest number of cancer-related deaths [1, 2]
Recent study results have indicated that the applicability of various scoring and staging systems was similar for the different types of transarterial chemoembolization (TACE) [45]. In this direct head-to-head comparison of three scoring systems for HCC prognosis, we found that the SAT was superior to the TBS and the SEC in survival stratification and in predictive ability
The SAT should be preferred when stratifying patients according to tumor burden; e.g., in the context of clinical trials

Summary

Introduction

Hepatocellular carcinoma (HCC) is the fifth most common cancer entity worldwide and is responsible for the second-highest number of cancer-related deaths [1, 2]. Following the current guidelines from the European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD), the Barcelona Clinic Liver Cancer (BCLC) classification system is the preferred framework for treatment allocations and prognosis predictions [3, 4]. According to the BCLC classification, transarterial chemoembolization (TACE) is the standard of care for patients with intermediate-stage HCC [5, 6]. There is substantial heterogeneity among patients with intermediate-stage HCC, due to considerable differences in tumor burden and liver function [7]. This heterogeneity hampers prognosis prediction, and it remains difficult to make treatment decisions for these patients.

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