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

Müller, Lukáš; Hähn, Felix; Auer, Timo Alexander; Fehrenbach, Uli; Gebauer, Bernhard; Haubold, Johannes; Zensen, Sebastian; Kim, Moon-Sung; Eisenblätter, Michel; Diallo, Thierno D.; Bettinger, Dominik; Steinle, Verena; Chang, De‐Hua; Zopfs, David; Santos, Daniel Pinto dos; Kloeckner, Roman

doi:10.3389/fonc.2022.850454

Cited by 11 publications

(7 citation statements)

References 47 publications

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“…TBS was defined as the distance from the origin of a Cartesian plane using maximum tumor size as the X-axis and tumor number as the Y-axis (9). As previously reported, TBS is a valuable tool in evaluating prognosis for colorectal liver metastases, HCC, and ICC (13,26,27). The present study assessed the significance of TBS in dictating the prognosis of patients with cHCC-CCA after curative liver resection.…”

Section: Discussionmentioning

confidence: 76%

Tumor burden score dictates prognosis of patients with combined hepatocellular cholangiocarcinoma undergoing hepatectomy

et al. 2023

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BackgroundThe prognostic value of the tumor burden score (TBS) in patients with combined hepatocellular-cholangiocarcinoma (cHCC-CCA) remains unknown. This study aimed to investigate the impact of TBS on long-term outcomes after surgery.MethodsPatients who underwent radical-intent resection between June 2013 and December 2019 were retrospectively reviewed. Kaplan–Meier curves were used to analyze patient survival, and disease-free survival (DFS) and overall survival (OS) were examined in relation to TBS.ResultsA total of 178 patients were included in this study, with 119 in the training cohort and 59 in the validation cohort. Kaplan–Meier curves showed that TBS was a strong prognostic indicator in patients with cHCC-CCA. Elevated TBS was associated with poorer DFS and OS (both P-value < 0.001) and was identified as an independent prognostic indicator. In addition, the prognostic value of TBS outperformed tumor size and number alone, microvascular invasion, and lymph node invasion. The prognostic significance of TBS was confirmed by the internal validation cohort.ConclusionsThe present study suggested the significance of tumor morphology in assessing the prognosis of patients with cHCC-CCA who undergoing curative resection. The TBS is a promising prognostic index in patients with cHCC-CCA. Elevated TBS was related to a lower long-term survival rate and was identified as an independent risk factor for poor DFS and OS. Further research is needed to verify our results.

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Section: Discussionmentioning

confidence: 76%

Tumor burden score dictates prognosis of patients with combined hepatocellular cholangiocarcinoma undergoing hepatectomy

et al. 2023

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“…Tumor burden, as measured by its largest size and number of tumors, is a common factor that has been incorporated into many HCC prognostic models, similar to our scoring system ( 17 , 28 – 31 ). Previous studies have shown that tumor burden is significantly associated with the survival rate of HCC patients ( 27 , 32 , 33 ). Unlike liver transplantation criteria ( 28 , 34 ), there was no defined threshold for tumor burden to be an absolute contraindication for TACE.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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BackgroundPatients with un-resectable hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE) are a diverse group with varying overall survival (OS). Despite the availability of several scoring systems for predicting OS, one of the unsolved problems is identifying patients who might not benefit from TACE. We aim to develop and validate a model for identifying HCC patients who would survive <6 months after their first TACE.MethodsPatients with un-resectable HCC, BCLC stage 0-B, who received TACE as their first and only treatment between 2007 and 2020 were included in this study. Before the first TACE, demographic data, laboratory data, and tumor characteristics were obtained. Eligible patients were randomly allocated in a 2:1 ratio to training and validation sets. The former was used for model development using stepwise multivariate logistic regression, and the model was validated in the latter set.ResultsA total of 317 patients were included in the study (210 for the training set and 107 for the validation set). The baseline characteristics of the two sets were comparable. The final model (FAIL-T) included AFP, AST, tumor sIze, ALT, and Tumor number. The FAIL-T model yielded AUROCs of 0.855 and 0.806 for predicting 6-month mortality after TACE in the training and validation sets, respectively, while the “six-and-twelve” score showed AUROCs of 0.751 (P < 0.001) in the training set and 0.729 (P = 0.099) in the validation sets for the same purpose.ConclusionThe final model is useful for predicting 6-month mortality in naive HCC patients undergoing TACE. HCC patients with high FAIL-T scores may not benefit from TACE, and other treatment options, if available, should be considered.

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“…It has been previously reported that tumor burden influences the survival and tumor response of patients with HCC. 33 , 34 Hence, BCLC stage A or stage B patients with a single tumor of length ≤5 cm, a single tumor of length >5 cm, or multiple tumors were included for subgroup analysis. The results revealed that the PFS risk in patients subjected to TACE-P-based treatment methods was higher than that in patients subjected to TACE-R-based treatment methods (the results were obtained when patients with a single tumor no more than 5 cm in length (following PSM) were studied).…”

Section: Discussionmentioning

confidence: 99%

Effect of Transarterial Chemoembolization Plus Percutaneous Ethanol Injection or Radiofrequency Ablation for Liver Tumors

Chen¹,

Zhang²,

Sun³

et al. 2022

JHC

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Background The efficacy of the transarterial chemoembolization (TACE) process combined with percutaneous ethanol injection (PEI, TACE-P) or the radiofrequency ablation (RFA, TACE-R) process was found to be good when used for the treatment of patients suffering from early or intermediate hepatocellular carcinoma (eiHCC). The study was conducted to compare the efficacy and safety of the TACE-P with TACE-A processes followed during the treatment of patients with eiHCC. Methods A total of 241 patients suffering from eiHCC, subjected to TACE-P (147 patients) or TACE-R (94 patients) processes from January 1, 2014, to December 31, 2018, were retrospectively reviewed and included. The propensity score matching (PSM) method was used to reduce selection bias. Results The median overall survival (mOS) and progression-free survival (mPFS) of the TACE-P group were similar to those recorded for the TACE-R group ( P >0.05) before using the PSM technique. Similar results were obtained post the use of the PSM technique. In the subgroup analysis after PSM, patients with single tumor (dimension: ≤5 cm), who were subjected to TACE-P-based treatment methods, exhibited worse tumor response than patients subjected to TACE-R-based methods (HR: 1.804, 95% CI: 1.083–3.005, P =0.023). Seven adverse events were reported. A statistically significant difference for all grades of adverse events (and grade III or IV adverse events) between the two groups (all P >0.05) was not reported. Conclusion The benefits and advantages of using the TACE-P based method was similar was those obtained using the TACE-R in patients with eiHCC, especially for patients with a single large tumor or multiple tumors.

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

Cited by 11 publications

References 47 publications

Tumor burden score dictates prognosis of patients with combined hepatocellular cholangiocarcinoma undergoing hepatectomy

Tumor burden score dictates prognosis of patients with combined hepatocellular cholangiocarcinoma undergoing hepatectomy

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

Effect of Transarterial Chemoembolization Plus Percutaneous Ethanol Injection or Radiofrequency Ablation for Liver Tumors

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