Expected outcomes and patients’ selection before chemoembolization—“Six-and-Twelve or Pre-TACE-Predict” scores may help clinicians: Real-life French cohorts results

Abstract

BACKGROUND Careful selection of hepatocellular carcinoma (HCC) patients prior to chemoembolization treatment is a daily reality, and is even more necessary with new available therapeutic options in HCC. AIM To propose two new models to better stratify patients and maximize clinical benefit: “6 and 12” and “pre/post-TACE-predict” (TACE, transarterial chemoembolization). METHODS We evaluated and compared their performance in predicting overall survival with other systems {Barcelona Clinic Liver Cancer (BCLC), Albumin-Bilirubin (ALBI) and NIACE [Number of tumor(s), Infiltrative HCC, alpha-fetoprotein, Child-Pugh (CP), and performance status]} in two HCC French cohorts of different stages enrolled between 2010 and 2018. RESULTS The cohorts included 324 patients classified as BCLC stages A/B (cohort 1) and 137 patients classified as BCLC stages B/C (cohort 2). The majority of the patients had cirrhosis with preserved liver function. “Pre-TACE-predict” and “6 and 12” models identified three distinct categories of patients exhibiting different prognosis in cohort 1. However, their prognostic value was no better than the BCLC system or NIACE score. Liver function based on CP and ALBI grades significantly impacted patient survival. Conversely, the “post-TACE-predict” model had a higher predictive value than other models. The stratification ability as well as predictive performance of these new models in an intermediate/advanced stage population was less efficient (cohort 2). CONCLUSION The newly proposed “Pre-TACE-predict” and “6 and 12” models offer an interesting stratification into three categories in a recommended TACE population, as they identify poor candidates, those with partial control and durable response. The models' contribution was reduced in a population with advanced stage HCCs.

FAIL-T (AFP, AST, tumor sIze, ALT, and Tumor number): a model to predict intermediate-stage HCC patients who are not good candidates for TACE

“…Therefore, its utility in helping physicians in determining which HCC patients are not suitable for TACE is limited. Moreover, subsequent external validation studies showed that the “six-and-twelve” score had a lower prognostic ability, with AUROCs ranging from 0.59 to 0.699 ( 16 , 32 , 35 – 37 ), when compared to the original Wang et al ( 17 ) cohort (0.73).…”

Mapping research trends of transarterial chemoembolization for hepatocellular carcinoma from 2012 to 2021: A bibliometric analysis

“…A recent study by Wang et al [ 26 ] developed an easy-to-use model, referred to as the "six-and twelve" score, which stratifies ideal TACE candidates based on the sum of tumor size and number of lesions. Unfortunately, the results of some external validation studies suggested that the model only has a modest predictive ability[ 27 , 28 ]. More recently, Han et al [ 29 ] developed a survival prediction model that assesses patients prior to initial TACE.…”

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

“…In the original study on the SAT, the score outperformed the BCLC classification and the ALBI score in predictive ability. In external validation studies, the C-Indexes for the SAT ranged between 0.60 and 0.70 ( 14 – 18 ). However, in all the validation studies, the predictive performance of the SAT was within the same range or somewhat below the performance of the BCLC and ALBI scoring systems ( 14 ).…”

“…It sums the number of tumor nodes and tumor size to obtain a readily applicable stratification system. In the original study, the score showed promising performance, but in an external validation, contrary results were found for the prognosis prediction (14)(15)(16)(17)(18).…”