The ART of decision making: Retreatment with transarterial chemoembolization in patients with hepatocellular carcinoma
The ART of decision making: Retreatment with transarterial chemoembolization in patients with hepatocellular carcinoma
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DOI：
10.1002/hep.26256
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发表时间：
2013-06-01
期刊：
影响因子：
13.5
通讯作者：
Peck-Radosavljevic, Markus
中科院分区：
文献类型：
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作者：
Sieghart, Wolfgang;Hucke, Florian;Peck-Radosavljevic, Markus
我们的目的是建立一个客观的积分来指导肝细胞癌患者再次接受肝动脉化疗栓塞术(TACE)的决定。总共有222名在1999年1月至2009年12月期间在维也纳医科大学消化/肝科(培训队列)和因斯布鲁克(验证队列)接受多次TACE治疗的肝细胞癌患者纳入研究。我们研究了第一次TACE对肝功能和肿瘤反应参数的影响及其对总生存期的影响(OS，LOG RANK检验)，并采用逐步COX回归模型在训练队列(n=107，维也纳)中制定了分数(ART评分：TACE复治评估)。ART评分在一个独立的验证队列中进行外部验证(n=115，因斯布鲁克)。天冬氨酸氨基转移酶升高25%(风险比8.4P<；0.001)，Child-Pugh评分较基线增加1(HR2.0)或2分(HR4.4)(P<；0.001)，以及无放射肿瘤反应(HR1.7；P=0.026)仍是OS的独立负面预后因素，并用于创建ART评分。ART评分分为两组(0~1.5分；2.5分)，预后不同(中位数OS：23.7vs6.6月；P<；0.001)，ART评分越高，第二次TACE后发生的主要不良事件越多(P=0.011)。这些结果在外部验证队列中得到了证实，并且与第二次TACE前的Child-Pugh分期和腹水的存在无关，仍然具有显着性。结论：第二次TACE前ART评分为2.5分，表明患者预后不佳，可能无法从进一步的TACE治疗中获益。(《肝病》2013；57：2261-2273)
We aimed to establish an objective point score to guide the decision for retreatment with transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). In all, 222 patients diagnosed with HCC and treated with multiple TACE cycles between January 1999 and December 2009 at the Departments of Gastroenterology/Hepatology of the Medical Universities of Vienna (training cohort) and Innsbruck (validation cohort) were included. We investigated the effect of the first TACE on parameters of liver function and tumor response and their impact on overall survival (OS, log rank test) and developed a point score (ART score: Assessment for Retreatment with TACE) in the training cohort (n = 107, Vienna) by using a stepwise Cox regression model. The ART score was externally validated in an independent validation cohort (n = 115, Innsbruck). The increase of aspartate aminotransferase (AST) by >25% (hazard ratio [HR] 8.4; P < 0.001), an increase of Child-Pugh score of 1 (HR 2.0) or 2 points (HR 4.4) (P < 0.001) from baseline, and the absence of radiologic tumor response (HR 1.7; P = 0.026) remained independent negative prognostic factors for OS and were used to create the ART score. The ART score differentiated two groups (0-1.5 points; 2.5 points) with distinct prognosis (median OS: 23.7 versus 6.6 months; P < 0.001) and a higher ART score was associated with major adverse events after the second TACE (P = 0.011). These results were confirmed in the external validation cohort and remained significant irrespective of Child-Pugh stage and the presence of ascites prior the second TACE. Conclusion: An ART score of 2.5 prior the second TACE identifies patients with a dismal prognosis who may not profit from further TACE sessions. (HEPATOLOGY 2013;57:2261-2273)