Recommendations for the use of chemoembolization in patients with hepatocellular carcinoma: Usefulness of scoring system?

Abstract

Several hepatocellular carcinoma (HCC) staging systems have been established, and a variety of countryspecific treatment strategies are also proposed. The barcelona -clinic liver cancer (BCLC) system is the most widely used in Europe. The Hong Kong liver Cancer is a new prognostic staging system; it might become the reference system in Asia. Transarterial chemoembolization (TACE) is the most widely used treatment for HCC worldwide; but it showed a benefit only for intermediate stage HCC (BCLC B), and there is still no consensus concerning treatment methods and treatment strategies. In view of the highly diverse nature of HCC and practices, a scoring system designed to assist with decision making before the first TACE is performed or prior to repeating the procedure would be highly useful.

The problem of current classications of the hepatocellular carcinoma. Analytical review

“…Определены две прогностические подгруп-пы при изучении азиатской серии пациентов с ТАХЭ [41]. Интересно, что HAP не прошла валидизацию для ТАХЭ на мультицентрической европейской когорте [63]. Это был ожидаемый результат, так как исследовались случаи ГЦР > 70 мм, а эффективность лечения ТАХЭ основана на размере узла обычно < 50 мм [42,62].…”

“…При значении > 2 баллов не рекомендуется продолжать ТАХЭ. Однако попытки привязать данные шкалы для оценки по-сле второго или третьего курса ТАХЭ не увенчались успе-хом [63,65]. После повторной ТАХЭ показатели шкалы ART не коррелируют с выживаемостью.…”

Usefulness of staging systems and prognostic scores for hepatocellular carcinoma treatments

“…Using a threshold value of 3, the NIACE score identified two groups presenting a significantly different survival (NIACE ≤ 3:27 mo (24-31) vs NIACE > 3:7 mo (6-10), p < 0.0001), even without any stage C patients ( Figure 6) [60] . It also separated two subgroups with distinct prognosis from an Asian cohort of patients treated by TACE [39] , as opposed to the HAP score which failed to prove its ability to select all the "good" candidates for TACE from a multicenter European cohort (with similar survival between the subgroups) [61] . Such a result could be anticipated as the same rating (1 point) is attributed to each variable and only HCC > 70 mm are taken into account, whereas the efficiency of the TACE treatment relies on the size (generally < 50 mm) and the number of nodules.…”

“…Both scores are usable after the second treatment. From a European multicenter cohort, the ART score calculated before the second or the third TACE failed to orientate the treatment option for all the patients [61,63] . If, unlike the ABCR, it did discriminate two different prognosis subgroups, the evolution of the ART score was not correlated with survival.…”

Study to evaluate the immunomodulatory effects of radiofrequency ablation compared to surgical resection for liver cancer

“…According to Barcelona Clinic Liver Cancer (BCLC) staging system 10 , 11 , liver resection (LR), liver transplantation and percutaneous local ablation including RFA, microwave ablation and so on are recommended as curative therapies for patients with early-stage primary and limited secondary liver tumours (<3cm) with a 5-year survival rate of 50-75% 12 - 17 . However, in patients with intermediate HCC or liver metastasis >3 cm, transarterial chemoembolization (TACE) or transarterial embolization (TAE) in combination with liver resection (LR) may offer a median survival ranging from 16 to 22 month 18 - 20 (Figure 1 ). Hence, the use of non-surgical modalities either alone or in combination with surgical resection are often required owing to inadequate functional hepatic reserve, unfavourable anatomical location, stage of liver cancer and multifocal involvement 21 , 22 .…”