Florian Hucke1, Matthias Pinter1, Ivo Graziadei2, Simona Bota1, Wolfgang Vogel2, Christian Müller1, Harald Heinzl3, Fredrik Waneck4, Michael Trauner1, Markus Peck-Radosavljevic1, Wolfgang Sieghart5. 1. Division of Gastroenterology and Hepatology, Department of Internal Medicine III, AKH & Medical University of Vienna, Austria. 2. Department of Gastroenterology and Hepatology, LKH & Medical University of Innsbruck, Austria. 3. Section for Clinical Biometrics, Medical University of Vienna, Austria. 4. Department of Interventional Radiology, Medical University of Vienna, Austria. 5. Division of Gastroenterology and Hepatology, Department of Internal Medicine III, AKH & Medical University of Vienna, Austria. Electronic address: wolfgang.sieghart@meduniwien.ac.at.
Abstract
BACKGROUND & AIMS: We aimed to establish an objective point score to guide the decision for the first treatment with transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). METHODS: 277 patients diagnosed with HCC and treated with transarterial treatments between 1/2002 and 12/2011 at the Medical Universities of Vienna (training cohort) and Innsbruck (validation cohort) were included. We investigated the impact of baseline liver function and tumour load on overall survival (OS, log-rank test) and developed a point score (STATE-score: Selection for TrAnsarterial chemoembolisation TrEatment) in the training-cohort (n=131, Vienna) by using a stepwise Cox regression model. The STATE-score was externally validated in an independent validation cohort (n=146, Innsbruck) and thereafter combined with the Assessment for Retreatment with TACE (ART)-score to identify patients who are (un)suitable for TACE. RESULTS: The STATE-score starts with the serum-albumin level (g/L), which is reduced by 12 points each, if the tumour load exceeds the up-to-7 criteria and/or C-reactive protein (CRP) levels are ⩾1 mg/dl (maximum reduction: 24 points). The STATE-score differentiated 2 groups (<18, ⩾18 points) with distinct prognosis (median OS: 5.3 vs. 19.5 months; p<0.001) and a lower STATE-score was associated with short-term harm and increased mortality after TACE-1 (39% vs. 14% p<0.001). Sequential use of the STATE and the ART-score (START-strategy) identified the most (un)suitable patients for TACE. Results were confirmed in the external validation-cohort and were independent from recently proposed baseline selection tools. CONCLUSION: The STATE-score identifies patients who are (un)suitable for the first TACE. The START-strategy identified the best candidates for multiple TACE sessions.
BACKGROUND & AIMS: We aimed to establish an objective point score to guide the decision for the first treatment with transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). METHODS: 277 patients diagnosed with HCC and treated with transarterial treatments between 1/2002 and 12/2011 at the Medical Universities of Vienna (training cohort) and Innsbruck (validation cohort) were included. We investigated the impact of baseline liver function and tumour load on overall survival (OS, log-rank test) and developed a point score (STATE-score: Selection for TrAnsarterial chemoembolisation TrEatment) in the training-cohort (n=131, Vienna) by using a stepwise Cox regression model. The STATE-score was externally validated in an independent validation cohort (n=146, Innsbruck) and thereafter combined with the Assessment for Retreatment with TACE (ART)-score to identify patients who are (un)suitable for TACE. RESULTS: The STATE-score starts with the serum-albumin level (g/L), which is reduced by 12 points each, if the tumour load exceeds the up-to-7 criteria and/or C-reactive protein (CRP) levels are ⩾1 mg/dl (maximum reduction: 24 points). The STATE-score differentiated 2 groups (<18, ⩾18 points) with distinct prognosis (median OS: 5.3 vs. 19.5 months; p<0.001) and a lower STATE-score was associated with short-term harm and increased mortality after TACE-1 (39% vs. 14% p<0.001). Sequential use of the STATE and the ART-score (START-strategy) identified the most (un)suitable patients for TACE. Results were confirmed in the external validation-cohort and were independent from recently proposed baseline selection tools. CONCLUSION: The STATE-score identifies patients who are (un)suitable for the first TACE. The START-strategy identified the best candidates for multiple TACE sessions.
Authors: L Cardarelli-Leite; A Hadjivassiliou; D Klass; J Chung; S G F Ho; H J Lim; P T W Kim; A Mujoomdar; D M Liu Journal: Curr Oncol Date: 2020-11-01 Impact factor: 3.677
Authors: Xavier Adhoute; Guillaume Penaranda; Jean Luc Raoul; Patrice Le Treut; Emilie Bollon; Jean Hardwigsen; Paul Castellani; Hervé Perrier; Marc Bourlière Journal: World J Hepatol Date: 2016-06-18
Authors: Claudia Campani; Alessandro Vitale; Gabriele Dragoni; Umberto Arena; Giacomo Laffi; Umberto Cillo; Edoardo G Giannini; Francesco Tovoli; Gian Ludovico Rapaccini; Maria Di Marco; Eugenio Caturelli; Marco Zoli; Rodolfo Sacco; Giuseppe Cabibbo; Andrea Mega; Maria Guarino; Antonio Gasbarrini; Gianluca Svegliati-Baroni; Francesco Giuseppe Foschi; Elisabetta Biasini; Alberto Masotto; Gerardo Nardone; Giovanni Raimondo; Francesco Azzaroli; Gianpaolo Vidili; Maurizia Rossana Brunetto; Fabio Farinati; Franco Trevisani; Fabio Marra Journal: Liver Cancer Date: 2021-03-17 Impact factor: 11.740