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Validation and reappraisal of the assessment for retreatment with transarterial chemoembolization score for unresectable non-metastatic hepatocellular carcinoma in a hepatitis b virus-endemic region

  • Oncology
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To validate and reappraise the Assessment for Retreatment with Transarterial chemoembolization (ART) score comprising three parameters (>25 % increase in aspartate aminotransferase [AST], increase in Child-Pugh score and tumour response), determined prior to subsequent transarterial chemoembolization (TACE).

Methods

Enrolled patients were diagnosed with unresectable non-metastatic hepatocellular carcinoma and underwent multiple TACEs between June 2006 and December 2007 (N = 153). Subgroupings were classified according to the established cut-off (≤1.5 vs. ≥2.5). Survival analysis using the Kaplan-Meier curve was performed.

Results

The original ART score dichotomized patients according to their overall survival (P = 0.004). We found several patients who actually survived longer than others were assigned to a poor prognostic group due to the AST component. Parameter estimates for AST obtained from our analysis were much lower than the original version (0.5 vs. 2.1). We adjusted the component according to the value of our parameter estimates, and patients with >25 % AST increase received 1.0 point. After this modification, patients assigned to the favourable prognostic group were more likely to have a better survival outcome (median 23.9 vs. 12.2 months, P < 0.001).

Conclusions

In hepatitis B virus-endemic regions, the ART score is valid and can better predict post-TACE survival after the AST component is modified.

Key Points

• The ART score was validated in a HBV-endemic region.

• The modified ART score improved prognostic performance by reappraising the AST component.

• The modified ART score helps physicians make decisions for further TACE.

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Abbreviations

HCC:

hepatocellular carcinoma

BCLC:

Barcelona clinic liver cancer

TACE:

transarterial chemoembolization

ART:

Assessment for retreatment with transarterial chemoembolization

AST:

aspartate aminotransferase

OS:

overall survival

EASL:

European Association for the Study of Liver

HBV:

hepatitis B virus

CT:

computed tomography

AFP:

alpha-fetoprotein

HR:

hazard ratio

NRI:

net reclassification improvement

CI:

confidence interval

SD:

standard deviation

DEB:

drug-eluting bead

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Acknowledgments

The scientific guarantor of this publication is Dr. Han Chu Lee. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors (Jung Bok Lee) has significant statistical expertise. Institutional Review Board approval was obtained.

Written informed consent was waived by the Institutional Review Board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

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Authors and Affiliations

  1. Department of Gastroenterology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea

    Yeonjung Ha, Ju Hyun Shim, Kang Mo Kim, Young-Suk Lim & Han Chu Lee

  2. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea

    Jung Bok Lee

  3. Department of Radiology, Asan Liver Center, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea

    Hyun-Ki Yoon & Yong Moon Shin

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  1. Yeonjung Ha
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  2. Jung Bok Lee
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Correspondence to Han Chu Lee.

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Ha, Y., Lee, J.B., Shim, J.H. et al. Validation and reappraisal of the assessment for retreatment with transarterial chemoembolization score for unresectable non-metastatic hepatocellular carcinoma in a hepatitis b virus-endemic region. Eur Radiol 26, 3510–3518 (2016). https://doi.org/10.1007/s00330-015-4185-2

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  • DOI: https://doi.org/10.1007/s00330-015-4185-2

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