NIACE score for hepatocellular carcinoma patients treated by surgery or transarterial chemoembolization

Adhoute, Xavier; Pénaranda, Guillaume; Raoul, Jean‐Luc; Bollon, Emilie; Pol, Bernard; Letreut, Y.P.; Perrier, H.; Bayle, Olivier; Monnet, O.; Beaurain, Patrick; Muller, Cyril; Hardwigsen, Jean; Lefolgoc, G.; Castellani, Paul; Bronowicki, Jean Pierre; Bourlière, Marc

doi:10.1097/meg.0000000000000852

Cited by 15 publications

(9 citation statements)

References 49 publications

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“…(29) The heterogeneity of intermediate-stage HCC and the widespread use of TACE outside recommended guidelines has encouraged the development of scores that can predict survival after TACE using baseline clinical features. (10,12,14,(30)(31)(32) The first of these, the HAP score, has been internationally validated and enhanced by the addition of a fifth variable, namely tumor number. (13,23,33) Recognizing the limitations of points-based scores, Cappelli et al built a model (known as mHAP-III) based on the mHAP-II score but using the same variables in their continuous form, which permitted individual patient prognostication.…”

Section: Discussionmentioning

confidence: 99%

Prediction of Survival Among Patients Receiving Transarterial Chemoembolization for Hepatocellular Carcinoma: A Response‐Based Approach

et al. 2020

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Background and Aims The heterogeneity of intermediate‐stage hepatocellular carcinoma (HCC) and the widespread use of transarterial chemoembolization (TACE) outside recommended guidelines have encouraged the development of scoring systems that predict patient survival. The aim of this study was to build and validate statistical models that offer individualized patient survival prediction using response to TACE as a variable. Approach and Results Clinically relevant baseline parameters were collected for 4,621 patients with HCC treated with TACE at 19 centers in 11 countries. In some of the centers, radiological responses (as assessed by modified Response Evaluation Criteria in Solid Tumors [mRECIST]) were also accrued. The data set was divided into a training set, an internal validation set, and two external validation sets. A pre‐TACE model (“Pre‐TACE‐Predict”) and a post‐TACE model (“Post‐TACE‐Predict”) that included response were built. The performance of the models in predicting overall survival (OS) was compared with existing ones. The median OS was 19.9 months. The factors influencing survival were tumor number and size, alpha‐fetoprotein, albumin, bilirubin, vascular invasion, cause, and response as assessed by mRECIST. The proposed models showed superior predictive accuracy compared with existing models (the hepatoma arterial embolization prognostic score and its various modifications) and allowed for patient stratification into four distinct risk categories whose median OS ranged from 7 months to more than 4 years. Conclusions A TACE‐specific and extensively validated model based on routinely available clinical features and response after first TACE permitted patient‐level prognostication.

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Section: Discussionmentioning

confidence: 99%

Prediction of Survival Among Patients Receiving Transarterial Chemoembolization for Hepatocellular Carcinoma: A Response‐Based Approach

et al. 2020

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“…The recommendation for TACE results from a multi-disciplinary discussion with different clinicians who should both know and master at least one model. Other systems include some additional key features that may affect OS[ 15 , 30 ], but those parameters are not routinely recorded such as tumor morphology due to lack of consensus regarding radiological procedures and criteria that should be applied. However, liver function remains a key criterion in our cohorts of cirrhotic patients as CP and ALBI grades also identified subgroups with different prognosis (Figures 1 and 3 ).…”

Section: Discussionmentioning

confidence: 99%

“…Risk stratification based on “pre-TACE-predict”, “6 and 12” and NIACE[ 15 ] [Number of tumor(s), Infiltrative HCC, AFP, CP class, and Eastern Cooperative Oncology Group (ECOG) PS] scores, Albumin-Bilirubin (ALBI)[ 16 ] grade and “post-TACE-predict” model were calculated (Table 1 ).…”

Section: Methodsmentioning

confidence: 99%

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

Adhoute¹,

Larrey²,

Anty³

et al. 2021

WJCC

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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.

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“…However, simplicity (using two cut-off values for risk stratification) and presumed reliability of the “6&12” score have convinced us to assess once again[ 6 ] the reproducibility and the predictive value of this new model in a multicenter French cohort of HCC patients including only recommended TACE candidates ( n = 324) ie intermediate and early unresectable stages according to the treatment stage migration concept. We compared it to other systems different from Wang et al[ 1 ]’s study (Barcelona Clinic Liver cancer[ 7 ] (BCLC) staging, Child-Pugh (CP) class, Albumin-Bilirubin[ 8 ] (ALBI) grade, NIACE[ 9 ] [tumor nodularity, infiltrative nature of the tumor, alpha-fetoprotein (AFP), CP class, and PS] score (Table 1 )) using time-dependent area under receiver operating characteristic curve (AUROC) values and C-indices.…”

Section: To the Editormentioning

confidence: 99%

“…By adding “the sum of largest tumor size and number”, it is true that consensus is easy to achieve among all clinicians. Moreover, other scores[ 9 ] encompass other baseline features that are likely to impact OS such as morphology of the tumor[ 18 ], but those parameters are not routinely recorded, which limits their use.…”

Section: To the Editormentioning

confidence: 99%

“Six-and-twelve” score for outcome prediction of hepatocellular carcinoma following transarterial chemoembolization. In-depth analysis from a multicenter French cohort

Adhoute

Pénaranda

Raoul

et al. 2020

WJH

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The “six-and-twelve” (6&12) score is a new hepatocellular carcinoma (HCC) prognostic index designed for recommended transarterial chemoembolization (TACE) candidates. Quick and easy to use by the sum of tumor size (cm) and number, this model identifies three groups with different survival time (the sum is ≤ 6; or > 6 but ≤ 12; or > 12); a survival benefit with TACE can be expected for HCC patients with a score not exceeding twelve. Recently, Wang ZW et al showed that the “6&12” model was the best system correlated with radiological response after the first TACE. Thus, we wanted to assess its survival prediction ability as well as its prognostic value and compared it to other systems (Barcelona Clinic Liver Cancer, Hong Kong Liver Cancer (HKLC) staging, Albumin-Bilirubin grade, tumor nodularity, infiltrative nature of the tumor, alpha-fetoprotein, Child-Pugh class, and Performance Status score, Cancer of the Liver Italian Program, Model to Estimate Survival for HCC scores, up-to-seven criteria) different from Wang ZW et al study in a multicenter French cohort of HCC including only recommended TACE candidates retrospectively enrolled. As previously demonstrated, we show that the "6&12” score can classify survival within this French cohort, with a prognostic value comparable to that of other systems, except HKLC staging. More importantly, the “6&12” score simplicity and ability in patients’ stratification outperform other systems for a routine clinical practice.

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NIACE score for hepatocellular carcinoma patients treated by surgery or transarterial chemoembolization

Abstract: In this study, among HCC patients treated according to the BCLC recommendations, the NIACE score predicts more accurately than any other system the survival time.

Cited by 15 publications

References 49 publications

Prediction of Survival Among Patients Receiving Transarterial Chemoembolization for Hepatocellular Carcinoma: A Response‐Based Approach

Prediction of Survival Among Patients Receiving Transarterial Chemoembolization for Hepatocellular Carcinoma: A Response‐Based Approach

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

“Six-and-twelve” score for outcome prediction of hepatocellular carcinoma following transarterial chemoembolization. In-depth analysis from a multicenter French cohort

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