Letters to the Editor
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Aug 27, 2020; 12(8): 525-532
Published online Aug 27, 2020. doi: 10.4254/wjh.v12.i8.525
“Six-and-twelve” score for outcome prediction of hepatocellular carcinoma following transarterial chemoembolization. In-depth analysis from a multicenter French cohort
Xavier Adhoute, Guillaume Pénaranda, Jean-Luc Raoul, Jean-Pierre Bronowicki, Rodolphe Anty, Marc Bourlière
Xavier Adhoute, Marc Bourlière, Department of Gastroenterology and Hepatology, Hôpital Saint-Joseph, Marseille 13008, France
Guillaume Pénaranda, AlphaBio Laboratory, Marseille 13003, France
Jean-Luc Raoul, Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Nantes 44805, France
Jean-Pierre Bronowicki, Department of Gastroenterology and Hepatology, Centre Hospitalo-Universitaire de, Nancy 54511, France
Rodolphe Anty, Department of Gastroenterology and Hepatology, Hôpital Universitaire de l’Archet, Nice 06200, France
Author contributions: Adhoute X, Raoul J, Bronowicki J and Bourlière M are physicians in charge of the patients; Adhoute X and Bronowicki J collected the data and Pénaranda G proceeded to statistical analysis; Adhoute X, Bronowicki J and Anty R wrote the manuscript.
Conflict-of-interest statement: The authors have no potential conflict of interest relevant to this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Adhoute Xavier, MD, Doctor, Department of Gastroenterology and Hepatology, Hôpital Saint-Joseph, 26 Bd de Louvain, Marseille 13008 France. adhoute.xavier@neuf.fr
Received: April 13, 2020
Peer-review started: April 13, 2020
First decision: April 22, 2020
Revised: July 5, 2020
Accepted: July 19, 2020
Article in press: July 19, 2020
Published online: August 27, 2020

The “six-and-twelve” (6&12) score is a new hepatocellular carcinoma (HCC) prognostic index designed for recommended transarterial chemoembolization (TACE) candidates. Quick and easy to use by the sum of tumor size (cm) and number, this model identifies three groups with different survival time (the sum is ≤ 6; or > 6 but ≤ 12; or > 12); a survival benefit with TACE can be expected for HCC patients with a score not exceeding twelve. Recently, Wang ZW et al showed that the “6&12” model was the best system correlated with radiological response after the first TACE. Thus, we wanted to assess its survival prediction ability as well as its prognostic value and compared it to other systems (Barcelona Clinic Liver Cancer, Hong Kong Liver Cancer (HKLC) staging, Albumin-Bilirubin grade, tumor nodularity, infiltrative nature of the tumor, alpha-fetoprotein, Child-Pugh class, and Performance Status score, Cancer of the Liver Italian Program, Model to Estimate Survival for HCC scores, up-to-seven criteria) different from Wang ZW et al study in a multicenter French cohort of HCC including only recommended TACE candidates retrospectively enrolled. As previously demonstrated, we show that the "6&12” score can classify survival within this French cohort, with a prognostic value comparable to that of other systems, except HKLC staging. More importantly, the “6&12” score simplicity and ability in patients’ stratification outperform other systems for a routine clinical practice.

Keywords: Hepatocellular carcinoma, Transarterial chemoembolization, “Six-and-twelve” score, Prognosis, Albumin-Bilirubin grade, Tumor nodularity, infiltrative nature of the tumor, alpha-fetoprotein, Child-Pugh class, and performance status score

Core tip: Not all-intermediate stage hepatocellular carcinoma (HCC) benefit from transarterial chemoembolization (TACE). The recent “six-and-twelve” (6&12) score is an easy to use prognostic model that ensure a quick and appropriate patient’ selection before the first TACE in Chinese cohorts. In this multicenter French cohort of HCC, the “6&12” score can also classify survival among recommended TACE candidates with a good prognostic performance. It may help clinicians in routine clinical practice.