Prognostic Score Predicting Overall Survival of Patients with Intermediate Stage of Hepatocellular Carcinoma after Transcatheter Transarterial Chemoembolization
Jarupongprapa S, MD1, Nimanong S, MD1, Chainuvati S, MD1, Charatcharoenwitthaya P, MD1, Tanwandee T, MD1, Srisajjakul S, MD2, Chotiyaputta W, MD1
Affiliation : 1 Division of Gastroenterology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand 2 Department of Radiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Except benefits, patients with intermediated stage of hepatocellular carcinoma undergoing Transcatheter arterial
chemoembolisation (TACE) might be dealt with TACE-related adverse events, especially liver decompensation. The aim of this
study is to develop a prognostic score for avoiding unnecessary retreatment with TACE.
Materials and Methods: A retrospective cohort study between January 2007 and December 2012 at Siriraj Hospital, Mahidol
University including 216 patients with intermediate stage of HCC undergoing consecutive TACE within 90 days. We investigated the
effect of baseline characteristics, liver function, and dynamic tumor response after TACE session on the median overall survival.
Results : Five independent parameters impacted on overall survival (OS) with statistical significance in multivariate analysis. These
factors were baseline Child-Pugh score (CTP) class B (hazard ratio [HR] 1.77, p = 0.04), the Barcelona Clinic Liver Cancer (BCLC)
stage B (HR 1.95, p = 0.001), increased CTP score (+1 [HR 2.29], +2 [HR 11.74], p<0.001], baseline AFP level >200 and <50%
reduction after TACE (HR 2.07, p = 0.003) as well as radiologic response (HR 1.56, p = 0.01). The new prognostic score was developed
and divided into 2 groups (<3 point and >3 point) with different prognosis (median OS 26.3 months vs. 10.7 months, p<0.001).
Furthermore, prognostic score of >3 point was associated with higher TACE related liver decompensation with relative risk 20.2
(p<0.001).
Conclusion : Patients with prognostic score >3 point prior second TACE had poor prognosis and high rate of major complication.
Retreatment with TACE should be avoided.
Keywords : Hepatocellular carcinoma, TACE, Chemoembolization, Prognosis
