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Feasibility of dynamic risk assessment for patients with repeated trans-arterial chemoembolization for hepatocellular carcinomaopen access

Park, YehyunKim, Beom KyungPark, Jun YongKim, Do YoungAhn, Sang HoonHan, Kwang-HyubYeon, Jong EunByun, Kwan SooKim, Hye SooKim, Ji HoonKim, Seung Up
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BioMed Central
Hepatocellular carcinoma; Trans-arterial chemoembolization; Risk prediction; Hepatoma arterial-embolization prognostic score
BMC Cancer, v.19, no.1
Journal Title
BMC Cancer
Background Hepatoma arterial-embolization prognostic (HAP) score and its modifications (modified HAP [mHAP] and mHAP-II), consisting of some or all of the following factors of tumor size, number, alpha-fetoprotein, bilirubin, and serum albumin, have been found to predict outcomes after trans-arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). We investigated the feasibility of using HAP-related risk scores for dynamic risk assessment during repeated TACE. Methods A total of 619 HCC patients treated with TACE from two institutions between 2003 and 2010 were included. Results Patients with A-B class risk scores showed significantly better survival than those with C-D class risk scores at the first (median 43.7 vs. 21.5 months for mHAP-II, 35.2 vs. 10.2 months for mHAP, and 39.8 vs. 18.6 months for HAP; all P < 0.001) and the second rounds of TACE (38.6 vs. 17.2 months for mHAP-II, 30.0 vs. 8.5 months for mHAP, and 32.6 vs. 17.3 months for HAP; all P < 0.001). Sequential assessment of risk scores at the second TACE round was applied for patients with A-B class risk scores at the first TACE round, which further identified two subgroups of A-B and C-D class risk scores with different outcomes (median survival 40.6 vs. 19.6 months for mHAP-II, 31.2 vs. 16.9 months for mHAP, and 35.8 vs. 21.0 months for HAP; all P < 0.001). Compared with mHAP and HAP, mHAP-II showed the highest likelihood ratio (22.61 vs. 14.67 and 13.97, respectively), highest linear trend (24.43 vs. 19.67 and 14.19, respectively), and lowest Akaike information criteria value (1432.51 vs. 3412.29 and 2296.98, respectively). Conclusions All HAP-related risk scores dynamically predicted outcomes during repeated TACE. Sequential risk assessment using mHAP-II best identified optimal candidates for repeated TACE.
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2. Clinical Science > Department of Gastroenterology and Hepatology > 1. Journal Articles


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Yeon, Jong Eun
Guro Hospital (Department of Gastroenterology and Hepatology, Guro Hospital)
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