A Novel Pre-treatment Model Predicting Risk of Developing Refractoriness to Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma

Abstract

Background and aim: Refractoriness to transarterial chemoembolization is common during the therapeutic process of hepatocellular carcinoma, which is an intractable issue and may compromise the prognosis. We aim to establish a pre-treatment model to identify patients with high risks of refractoriness. Methods: From 2010 to 2016, 824 treatment-naive patients who had initially underwent at least two sessions of transarterial chemoembolization in Zhongshan Hospital, Fudan University were retrospectively enrolled. These patients were randomly allocated into a training cohort and a validation cohort. The pre-treatment scoring model was established based on the clinical and radiological variables using logistic regression and nomogram. The discrimination and calibration of the model were also evaluated. Results: Logistic regression identified vascularization pattern, ALBI grade, serum alpha-fetoprotein level, serum γ-glutamyl transpeptidase level and major tumor size as the key parameters related to refractoriness. The p-TACE model was established using these variables (risk score range: 0-19.5). Patients were divided into six risk subgroups based on their scores (<4, ≥4, ≥7, ≥10, ≥13, ≥16). The discriminative ability, as determined by the area under receiver operating characteristic curve was 0.784 (95% confidence interval: 0.741-0.827) in the training cohort and 0.743 (95% confidence interval: 0.696-0.789) in the validation cohort. Moreover, satisfactory calibration was confirmed by Hosmer-Lemeshow test with P values of 0.767 and 0.913 in the training cohort and validation cohort. Conclusions: This study presents a pre-treatment model to identify patients with high risks of refractoriness after transarterial chemoembolization and shed light on clinical decision making.

Plasma arginase-1 as a predictive marker for early transarterial chemoembolization refractoriness in unresectable hepatocellular carcinoma

“…Increases in either tumor size or number lead to increased |tumor burdens that markedly influence liver cancer treatment outcomes (20,(27)(28)(29). Hu et al retrospectively analyzed the association between TACE refractoriness and various biomarkers; they proposed that the main risk factors for refractory TACE include AFP, some liver function indicators and tumor imaging findings (30). Taken together, these previous results are consistent with our findings.…”

Predicting early refractoriness of transarterial chemoembolization in patients with hepatocellular carcinoma using a random forest algorithm: A pilot study

“…Thus, appropriate judgement of TACE refractoriness is crucial. Several previous studies have reported predictive factors of TACE refractoriness 8 , 9 , however, the potential prediction of early TACE refractoriness have not been identified.…”

Re-evaluating Transarterial Chemoembolization Failure/Refractoriness: A Survey by Chinese College of Interventionalists

“…According to JSH-LGSGJ 2014 criteria, the incidence of TACE failure/refractoriness ranges from 37.0% to 49.3%. 13,14 Nevertheless, by emphasizing retrospective studies and consensus rather than high-level evidence, these definitions and subsequent treatment recommendations for TACE failure/refractoriness remain somewhat ambiguous and controversial. In addition, the epidemiological difference in research between Japan/Western countries and China reveals discrepancies in the extent of disease burden, whereby a relatively higher burden of HCC is reported in China.…”

“…According to JSH-LGSGJ 2014 criteria, the incidence of TACE failure/refractoriness ranges from 37.0% to 49.3%. 13 , 14 …”