Published online Apr 21, 2020. doi: 10.3748/wjg.v26.i15.1805
Peer-review started: December 12, 2019
First decision: January 7, 2020
Revised: March 13, 2020
Accepted: March 27, 2020
Article in press: March 27, 2020
Published online: April 21, 2020
Processing time: 129 Days and 22.8 Hours
Transarterial chemoembolization (TACE) is recommended for patients with intermediate hepatocellular carcinoma (HCC) according to treatment guidelines. However, a large number of patients with advanced HCC also receive TACE in clinical practice, especially for those with liver-confined HCC and Eastern Cooperative Oncology Group score (ECOG) 1. In view of previous studies, such patients have different prognoses from advanced HCC patients with macrovascular invasion or extrahepatic spread; therefore, patients with ECOG 1 alone might be classified into the intermediate stage and benefit from TACE treatment, but a study particularly focusing on such patients and exploring the effectiveness of TACE therapy is lacking.
To investigate treatment outcomes of TACE in HCC patients with ECOG 1 alone and propose a specific prognostic model.
Patients from 24 Chinese tertiary hospitals were selected in this nationwide multicenter observational study from January 2010 to May 2016. Overall survival (OS) was estimated using Kaplan–Meier curves and compared by the log-rank test. Multivariate Cox regression was used to develop the potential prognostic models. The discriminatory ability of the models was compared and validated in various patient subgroups. The individual survival prediction for six-and-twelve (6&12) criteria, defined as the algebraic sum of tumor size (cm) and tumor number, was illustrated by contour plot of 3-year survival probability and nomogram.
A total of 792 eligible patients were included. During follow-up, median OS reached 18.9 mo [95% confidence interval (CI): 16.9-21.0]. Three independent multivariate analyses demonstrated that tumor size, tumor number, α-fetoprotein level, albumin–bilirubin grade and total bilirubin were prognostic factors of OS (P < 0.05). The previously proposed 6&12 criteria was comparable or even better than currently proposed with the highest predictive ability. In addition, the 6&12 criteria was correlated with OS in various subgroups of patients. The patients were stratified into three strata with score ≤ 6, > 6 but ≤ 12, and > 12 with different median OS of 39.8 mo (95%CI: 23.9-55.7), 21.1 mo (95%CI: 18.4-23.8) and 9.8 mo (95%CI: 8.3-11.3), respectively (P < 0.001).
TACE is effective for advanced HCC patients with ECOG 1 alone, and the 6&12 criteria may help with clinical decision-making.
Core tip: According to the current treatment guidelines, patients with liver-confined hepatocellular carcinoma and Eastern Cooperative Oncology Group score of 1 alone should be classified as advanced stage and treated with systemic therapy. However, transarterial chemoembolization is commonly used for this group of patients in clinical practice. The current study retrospectively included 792 eligible patients from 24 Chinese tertiary hospitals and found transarterial chemoembolization was effective for hepatocellular carcinoma patients with Eastern Cooperative Oncology Group score of 1 alone, and the “six-and-twelve criteria”, defined as the algebraic sum of tumor size (cm) and tumor number, might help the risk stratification and survival prediction.