The ART-strategy: Sequential assessment of the ART score predicts outcome of patients with hepatocellular carcinoma re-treated with TACE

Hucke, Florian; Sieghart, Wolfgang; Pinter, Matthias; Graziadei, Ivo; Vogel, Wolfgang; Müller, Christian; Heinzl, Harald; Waneck, Fredrik; Trauner, Michael; Peck‐Radosavljevic, Markus

doi:10.1016/j.jhep.2013.08.022

Cited by 108 publications

(70 citation statements)

References 13 publications

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“…A number of studies demonstrated that the repetition of TACE increases tumor response and prolongs survival [9], but it is necessary to differentiate between patients who may and those who may not benefit from TACE and eventually subsequent retreatments in order to avoid detrimental effects on liver function induced by TACE in patients with a dismal prognosis. To this end, an objective score to guide the decision process for retreatment with TACE in HCC patients has been developed [13,14]. The issue of proper patient selection for retreatment after TACE has become more stringent especially considering possible alternative pharmacological systemic treatments [12].…”

Section: Discussionmentioning

confidence: 99%

“…To this end, the ART score (a point score for the assessment of retreatment with TACE) has been developed recently. This score divides HCC patients into two distinct patient groups with different prognoses and in particular was claimed to be able to differentiate between patients who are expected to benefit from multiple TACE sessions and patients who do not benefit from further TACE [13,14]. The primary endpoint of the present study was to confirm the ART score to be an objective point score to guide the decision making for TACE retreatment of HCC patients.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The ART Score Is Not Effective to Select Patients for Transarterial Chemoembolization Retreatment in an Italian Series

Terzi¹,

Terenzi²,

Venerandi³

et al. 2014

Dig Dis

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Background: The ART score (a point score for the assessment of retreatment with transarterial chemoembolization, TACE) has been recently developed in Austria to differentiate patients who may benefit from multiple sessions of TACE for hepatocellular carcinoma (HCC) treatment. The primary aim of the study was to test the validity of the ART score in an Italian study cohort. The secondary aims were to evaluate overall survival (OS) and clinical determinants of improved survival in patients treated with multiple TACE sessions. Methods: The ART score and the clinical outcome of 51 consecutive patients with HCC submitted to multiple TACE sessions from April 2002 to December 2009 were retrospectively analyzed. Results: Median OS was 26.0 months (95% confidence interval 18.4-33.6) with 1-, 3- and 5-year survival rates of 75, 33 and 11%, respectively). Thirty-three patients had an ART score of 0-1.5 and in 18 it was ≥2.5, but in our patient series, the ART score was not found to be a predictor of survival (p = 0.173). At univariate analysis, tumor extent (uni- vs. bilobar: 34.0 vs. 9.0 months; p < 0.001), Child-Pugh score before the second TACE (A vs. B7 vs. B8-9: 26.0 vs. 16.0 vs. 5.0 months; p = 0.005) and Child-Pugh score increase between the first and second TACE (absent vs. + 1 point vs. + ≥2 points: 27.0 vs. 4.0 vs. 5.0 months; p < 0.001) were statistically related with survival. At multivariate analysis, only Child-Pugh score increase remained a significant predictor of worse survival (p = 0.001, hazard rate = 11.6). Conclusions: The ART score was not found to work as an objective tool to guide TACE retreatment in our Italian patient series, only the Child-Pugh score increase was an independent predictor of a shorter survival.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The ART Score Is Not Effective to Select Patients for Transarterial Chemoembolization Retreatment in an Italian Series

Terzi¹,

Terenzi²,

Venerandi³

et al. 2014

Dig Dis

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show abstract

“…Sieghart et al [73] conducted a multivariate analysis to investigate TACE repeated for a second or third session and identified three prognostic factors: increase in aspartate aminotransferase by > 25%, increase in Child-Pugh score, and absence of tumor response. These factors were incorporated into an "ART" score, and patients with an ART score of 0-1.5 points benefitted from a second TACE, whereas those with a score ≥ 2.5 did not [74] .…”

Section: Tacementioning

confidence: 99%

Recent advances in multidisciplinary management of hepatocellular carcinoma

Gomaa¹

2015

WJH

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“…Based on this concept of intractable progression, various indexes have been recently generated, aimed to objectively decide when to interrupt TACE because of inefficiency or uselessness. Most of these indexes consider radiological response and liver function worsening as the main parameters for assessing TACE failure (77,79). Unfortunately, these indexes have not been externally validated and many of them are derived from cohorts of patients who initially were bad candidates for TACE.…”

Section: Improvements In the Treatment Of Intermediate-advanced Hccmentioning

confidence: 99%

New challenges in clinical research on hepatocellular carcinoma

Díaz-González¹,

Forner²,

C³

et al. 2015

Rev Esp Enferm Dig

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This is an updated review of screening, early diagnosis and treatment of hepatocellular carcinoma, focusing on the advancements occurred in the last years and highlighting the challenges in clinical research.Hepatocellular carcinoma (HCC) is nowadays the sixth most frequent cancer worldwide with up to 740,000 new cases diagnosed each year, and it is the third most prevalent cause of cancer-relateddeath worldwide (1). This neoplasm usually appears linked to an underlying liver disease, being one of the most relevant causes of death in patients diagnosed of liver cirrhosis (2,3). In the last years, important advancements in terms of diagnosis, staging and treatment of HCC, improving the management and outcome of the disease, have been made (4-7). Despite the fact that these improvements have absolutely changed natural history of HCC, there are several areas that still need further advancements.The aim of this document is to discuss some controversial aspects, which in our opinion constitute real challenges in clinical research of HCC.Key words: Hepatocellular carcinoma. Hepatic oncology. Sorafenib. Transarterial chemoembolization. AFP. IMPROVING EARLY DIAGNOSISFrom the basis that the only possibility to offer and apply treatments with curative intention is being able to diagnose HCC at early stages, when there are not cancer related symptoms. Since this option is only feasible if screening is performed in population at risk, scientific guidelines recommend performing abdominal ultrasonography (US) in every patient with liver cirrhosis. Despite the recommendation of HCC screening by the Spanish guidelines (4), one registry study performed in Spain which included 62 centers and 705 patients diagnosed of HCC within a period of time of 4 months showed that just 47% of HCC patients were diagnosed in the setting of surveillance and less than a half were diagnosed at early stage (8).This data shows that early diagnosis, a key issue to be able to significantly reduce HCC-related mortality, is one of the most relevant issues that deserve further efforts from scientific community. Aiming to evaluate which were the causes of screening program fail in the United States of America, Singal et al. evaluated 1,005 patients included in the HALT-C prospective study. A third part of patients did not adhere to an adequate screening program and, in 70% of cases that were diagnosed at an advanced stage, the main reason was the absence of detection in US (9).With the aim of improving detection rate, it is crucial to establish formative programs in order to certify the capability of being able to carry on this activity and it is necessary to use up-to-date ultrasonography scans in order to perform an optimal liver exploration. Tumor markers could be a useful tool to overcome theoretical limitations of US: its evaluation is not subjective, does not depend on the operator and it may be reproducible, as well as it is relatively cheap and a tool easy to access in areas with low monetary income. Regrettably, different tumor markers ev...

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The ART-strategy: Sequential assessment of the ART score predicts outcome of patients with hepatocellular carcinoma re-treated with TACE

Cited by 108 publications

References 13 publications

The ART Score Is Not Effective to Select Patients for Transarterial Chemoembolization Retreatment in an Italian Series

The ART Score Is Not Effective to Select Patients for Transarterial Chemoembolization Retreatment in an Italian Series

Recent advances in multidisciplinary management of hepatocellular carcinoma

New challenges in clinical research on hepatocellular carcinoma

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