New intermediate‐stage subclassification for patients with hepatocellular carcinoma treated with transarterial chemoembolization

Kim, Jin Hyoung; Shim, Ju Hyun; Lee, Han Chu; Sung, Kyu‐Bo; Ko, Heung‐Kyu; Ko, Gi‐Young; Gwon, Dong Il; Kim, Jong Woo; Lim, Young‐Suk; Park, Seong Ho

doi:10.1111/liv.13487

Cited by 84 publications

(98 citation statements)

References 20 publications

(64 reference statements)

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“…Kaplan–Meier analysis showed that the HAP model also significantly discriminated OS across HAP class A to D in the training and validation cohorts and the overall patients ( P < .001, Figure D‐F). The discriminatory ability of the ALBI‐TAE model was further compared to the HAP model, BCLC‐B subclassification and another recently reported new BCLC‐B subclassification using both the training and validation datasets as well as the overall cohort using AUROC curve, AICc and homogeneity. As shown in Table , the ALBI‐TAE model offered the lowest AICc values and highest homogeneity in both the training and validation datasets as well as the overall cohort.…”

Section: Resultsmentioning

confidence: 99%

“…The AST to Platelet Ratio Index (APRI) was calculated using the formula: ([AST/upper limit of normal]/platelet count [10 9 /L]) × 100 . The Up‐to‐7 criteria combined the number of tumours and size of the largest tumour, with the sum being no more than 7, whereas the up‐to‐11 criteria combined the number of tumours and size of the largest tumour, with the sum being no more than 11 …”

Section: Methodsmentioning

confidence: 99%

“…Owing to the significant degree of disease heterogeneity in BCLC stage B HCC, BCLC stage B subclassifications have been proposed, whereas several prognostic models have been developed to predict survival after TACE . Nevertheless, some of the prediction models were developed from HCC patients with various BCLC stages, suggesting an even more heterogeneous population.…”

Section: Introductionmentioning

confidence: 99%

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A new ALBI‐based model to predict survival after transarterial chemoembolization for BCLC stage B hepatocellular carcinoma

Lee

Hung

Liu

et al. 2019

Liver International

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Background & Aims Transarterial chemoembolization (TACE) is a standard treatment for Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma (HCC), but the outcome varied. This study aimed to develop a model to predict the outcome of TACE in HCC patients. Methods Consecutive 570 treatment‐naïve BCLC stage B HCC patients undergoing TACE as the initial treatment from 2007 to 2016 were retrospectively enrolled. Factors associated with survival were analysed. Patients undergoing TACE from 2007 to 2011 constituted the training cohort (n = 293), while patients undergoing TACE from 2012 to 2016 constituted the validation cohort (n = 277). Homogeneity and corrected Akaike information criterion (AICc) were compared between each prognostic model. Results A total of 1796 TACE sessions were performed for the 570 patients during the median follow‐up period of 18.3 months. By multivariate analysis, beyond up‐to‐11 criteria (hazard ratio [HR] = 1.694, P < .001), alpha‐foetoprotein >200 ng/mL (HR = 1.771, P < .001) and albumin‐bilirubin (ALBI) grade 2 or 3 (HR = 1.817, P < .001) were independent predictors of overall survival (OS) in the training cohort. An ALBI‐TAE model based on the three independent predictors of OS from the training cohort was developed to classify HCC patients into four subgroups. The performance of the ALBI‐TAE model was superior to other prognostic models with lowest AICc values and highest homogeneity in both the training and validation datasets as well as the overall cohort. Conclusions Albumin‐bilirubin grade is an important factor associated with survival in BCLC stage B HCC patients undergoing TACE. ALBI‐TAE model can be applied to select patients who can get most benefit from TACE.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A new ALBI‐based model to predict survival after transarterial chemoembolization for BCLC stage B hepatocellular carcinoma

Lee

Hung

Liu

et al. 2019

Liver International

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“…The most recent evaluation of the prognostic capability of the subclassification of Bolondi et al [16] has been carried out by Kim et al [23] on 821 patients treated with TACE. The B1, B2 and B3 subclasses showed significantly different survival rates between the contiguous stages with a median survival of 51.5, 26, and 14.8 months, respectively (p < 0.001 for each comparison with the contiguous stratum until B3); however, the discriminatory ability and the gradient monotonicity of the system disappeared between B3 and B4 since the median survival of B3 was worse than that of B4 patients (14.8 vs. 25 months, p = 0.025).…”

mentioning

confidence: 99%

“…In an attempt to estimate the potential applicability of these subclassifications in clinical practice, it should be noted that two of them [16,23] In the ECOG scale, PS 1 refers to patients not being able to engage in strenuous physical activity but being ambulatory and able to carry out work of a light or sedentary nature, such as light housework or office work. Therefore, PS 1 does not preclude access to any type of HCC treatment and, consequently, the Italian guidelines for the management of HCC patients have not accepted the exclusion of these patients from the BCLC B stage (or its substages) [30].…”

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confidence: 99%

Patients with Barcelona Clinic Liver Cancer Stages B and C Hepatocellular Carcinoma: Time for a Subclassification

Golfieri

Bargellini²,

Spreafico

et al. 2018

Liver Cancer

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Background: The Barcelona Clinic Liver Cancer (BCLC) intermediate and advanced stages (BCLC B and C) of hepatocellular carcinoma (HCC) both include heterogeneous populations. Patients classified as BCLC stage B present with different tumour burdens, and the recommended treatment is transarterial chemoembolization (TACE). A similar heterogeneity of tumour burden and liver function can be found among patients classified as BCLC stage C, which includes diverse clinical features (performance status [PS] 1–2), macrovascular invasion (MVI) including portal vein tumour (PVT) thrombosis, and/or extra-hepatic spread. Nonetheless, the anti-tumoural treatment formally recommended by Western guidelines is systemic therapy with sorafenib. Summary: Several proposals of subclassification for both these stages have been suggested in recent years, differentiating the more appropriate treatments for each substage. In particular, for BCLC stage C patients with PVT, therapeutic indications, clinical outcomes, and response to locoregional therapy are notably different in the presence of subsegmental, segmental or main PVT. Accordingly, liver resection and transarterial therapies, such as TACE or transarterial embolization (TAE) and ⁹⁰Y-radioembolization (TARE), can be performed in locally advanced HCC with intrahepatic MVI according to its extent. In fact, surgery and TACE/TAE/TARE have no contraindications in the presence of PVT limited to the subsegmental or segmental branches in Child-Pugh class A patients, whereas only TARE should be utilized when there is lobar branch involvement. The presence of PS 1 should not be sufficient to allocate patients to the advanced stage since this would preclude any potential treatment for HCC. Patients should be properly classified as BCLC C only in cases of main portal trunk PVT, and treated according to the guidelines, provided that they belong to Child-Pugh class A. Key Messages: Subclassifications of BCLC B and C stages are urgently needed and require validation in order to guide clinicians towards the most effective treatment option.

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Efficacy and predictors of survival in patients with solitary hepatocellular carcinoma larger than 5 cm undergoing transarterial chemoembolization

Chang

Chi

Lee

et al. 2021

Adv in Digestive Medicine

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For patients with solitary hepatocellular carcinoma (HCC) larger than 5 cm not suitable for surgical resection, transarterial chemoembolization (TACE) is an alternative treatment. However, the response rate and survival predictors after TACE remain unclear. This study aimed to evaluate the treatment response and survival in this population. Consecutive 161 treatment-naïve patients with solitary HCC larger than 5 cm undergoing TACE as the initial treatment were retrospective enrolled. Radiologic response after first TACE was evaluated by modified RECIST criteria. Factors associated with overall survival (OS) were analyzed. Complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) were observed in 8.7%, 24.8%, 32.9%, and 36% of patients, respectively. The median OS in patients with CR, PR, SD, and PD were 71.4, 44.8, 17.7, and 14.3 months, respectively. By multivariate analysis, tumor size greater than 10 cm (odds ratio = 0.403, P = .023) was the only factor associated with radiologic response. By multivariate analysis, ALBI grade 2 or 3 (hazard ratio [HR] = 2.169, P = .001), tumor size greater than 7 cm (HR = 1.833, P = .010), and achieving complete or partial response (HR = 0.505, P = .003) were independent predictors of OS. An ALBI-Response-Size (ARS) score was developed to classify patients into low, intermediate and high risk of mortality (median OS of 68.6, 27.1, and 12.5 months, respectively, P < .001). In conclusion, ALBI grade, tumor size, and radiologic response are important predictors of survival in patients with solitary HCC larger than 5 cm undergoing TACE. A prognostic model can be applied to discriminate patient's survival after TACE.

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New intermediate‐stage subclassification for patients with hepatocellular carcinoma treated with transarterial chemoembolization

Abstract: Our new BCLC B substaging system, with up-to-11 criteria and Child-Pugh class as main parameters, has excellent discriminatory power to subclassify TACE-treated patients into three prognostic substages.

Cited by 84 publications

References 20 publications

A new ALBI‐based model to predict survival after transarterial chemoembolization for BCLC stage B hepatocellular carcinoma

A new ALBI‐based model to predict survival after transarterial chemoembolization for BCLC stage B hepatocellular carcinoma

Patients with Barcelona Clinic Liver Cancer Stages B and C Hepatocellular Carcinoma: Time for a Subclassification

Efficacy and predictors of survival in patients with solitary hepatocellular carcinoma larger than 5 cm undergoing transarterial chemoembolization

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