“Six-and-twelve” score for outcome prediction of hepatocellular carcinoma following transarterial chemoembolization. In-depth analysis from a multicenter French cohort

Abstract

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.