Aline Mähringer-Kunz1, Roman Kloeckner2, Michael B Pitton2, Christoph Düber2, Irene Schmidtmann3, Peter R Galle4, Sandra Koch4,5, Arndt Weinmann4,5. 1. Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University, Langenbeckst. 1, 55131, Mainz, Germany. aline.maehringer-kunz@unimedizin-mainz.de. 2. Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University, Langenbeckst. 1, 55131, Mainz, Germany. 3. Institute of Medical Biostatistics, Epidemiology and Informatics, Johannes Gutenberg University, Obere Zahlbacher St. 69, 55131, Mainz, Germany. 4. Department of Internal Medicine, University Medical Center of the Johannes Gutenberg University, Langenbeckst. 1, 55131, Mainz, Germany. 5. Clinical Registry Unit (CRU), University Medical Center of the Johannes Gutenberg University, Langenbeckst. 1, 55131, Mainz, Germany.
Abstract
PURPOSE: Several scoring systems that guide patients' treatment regimen for transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) have been introduced, but none have gained widespread acceptance in clinical practice. The purpose of this study is to externally validate the Selection for TrAnsarterial chemoembolization TrEatment (STATE)-score and START-strategy [i.e., sequential use of the STATE-score and Assessment for Retreatment with TACE (ART)-score]. MATERIALS AND METHODS: From January 2000 to September 2015, 933 patients with HCC underwent TACE at our institution. All variables needed to calculate the STATE-score and implement the START-strategy were determined. STATE comprised serum albumin, up-to-seven criteria, and C-reactive protein (CRP). ART comprised an increase in aspartate aminotransferase, the Child-Pugh score, and a radiological tumor response. Overall survival was calculated, and multivariate analysis performed. In addition, the STATE-score and START-strategy were validated using the Harrell's C-index and integrated Brier score (IBS). RESULTS: The STATE-score was calculated in 228 patients. Low and high STATE-scores corresponded to median survival of 14.3 and 20.2 months, respectively. Harrell's C was 0.558 and IBS 0.133. For the STATE-score, significant predictors of survival were up-to-seven criteria (p = 0.006) and albumin (p = 0.022). CRP values were not predictive (p = 0.367). The ART-score was calculated in 207 patients. Combining the STATE-score and ART-score led to a Harrell's C of 0.580 and IBS of 0.132. CONCLUSION: The STATE-score was unable to reliably determine the suitability for initial TACE. The START-strategy only slightly improved the predictive ability compared to the ART-score alone. Therefore, neither the STATE-score nor START-strategy alone provides sufficient certainty for clear-cut clinical decisions.
PURPOSE: Several scoring systems that guide patients' treatment regimen for transarterial chemoembolization (TACE) of hepatocellular carcinoma (HCC) have been introduced, but none have gained widespread acceptance in clinical practice. The purpose of this study is to externally validate the Selection for TrAnsarterial chemoembolization TrEatment (STATE)-score and START-strategy [i.e., sequential use of the STATE-score and Assessment for Retreatment with TACE (ART)-score]. MATERIALS AND METHODS: From January 2000 to September 2015, 933 patients with HCC underwent TACE at our institution. All variables needed to calculate the STATE-score and implement the START-strategy were determined. STATE comprised serum albumin, up-to-seven criteria, and C-reactive protein (CRP). ART comprised an increase in aspartate aminotransferase, the Child-Pugh score, and a radiological tumor response. Overall survival was calculated, and multivariate analysis performed. In addition, the STATE-score and START-strategy were validated using the Harrell's C-index and integrated Brier score (IBS). RESULTS: The STATE-score was calculated in 228 patients. Low and high STATE-scores corresponded to median survival of 14.3 and 20.2 months, respectively. Harrell's C was 0.558 and IBS 0.133. For the STATE-score, significant predictors of survival were up-to-seven criteria (p = 0.006) and albumin (p = 0.022). CRP values were not predictive (p = 0.367). The ART-score was calculated in 207 patients. Combining the STATE-score and ART-score led to a Harrell's C of 0.580 and IBS of 0.132. CONCLUSION: The STATE-score was unable to reliably determine the suitability for initial TACE. The START-strategy only slightly improved the predictive ability compared to the ART-score alone. Therefore, neither the STATE-score nor START-strategy alone provides sufficient certainty for clear-cut clinical decisions.
Authors: Joseph H Yacoub; David Mauro; Andrew Moon; Aiwu R He; Mustafa R Bashir; Christine C Hsu; Thomas M Fishbein; Lauren M B Burke Journal: Abdom Radiol (NY) Date: 2021-04-16
Authors: Lukas Müller; Felix Hahn; Florian Jungmann; Aline Mähringer-Kunz; Fabian Stoehr; Moritz C Halfmann; Daniel Pinto Dos Santos; Jan Hinrichs; Timo A Auer; Christoph Düber; Roman Kloeckner Journal: Cancer Imaging Date: 2022-01-11 Impact factor: 3.909
Authors: Lukas Müller; Felix Hahn; Aline Mähringer-Kunz; Fabian Stoehr; Simon Johannes Gairing; Friedrich Foerster; Arndt Weinmann; Peter Robert Galle; Jens Mittler; Daniel Pinto Dos Santos; Michael Bernhard Pitton; Christoph Düber; Uli Fehrenbach; Timo Alexander Auer; Bernhard Gebauer; Roman Kloeckner Journal: United European Gastroenterol J Date: 2021-12-16 Impact factor: 4.623
Authors: Lukas Müller; Felix Hahn; Timo Alexander Auer; Uli Fehrenbach; Bernhard Gebauer; Johannes Haubold; Sebastian Zensen; Moon-Sung Kim; Michel Eisenblätter; Thierno D Diallo; Dominik Bettinger; Verena Steinle; De-Hua Chang; David Zopfs; Daniel Pinto Dos Santos; Roman Kloeckner Journal: Front Oncol Date: 2022-02-23 Impact factor: 6.244
Authors: Lukas Müller; Felix Hahn; Aline Mähringer-Kunz; Fabian Stoehr; Simon J Gairing; Friedrich Foerster; Arndt Weinmann; Peter R Galle; Jens Mittler; Daniel Pinto Dos Santos; Michael B Pitton; Christoph Düber; Roman Kloeckner Journal: Front Oncol Date: 2021-06-10 Impact factor: 6.244