Recommendations for the use of chemoembolization in patients with hepatocellular carcinoma: Usefulness of scoring system?

Table 1 Overall survival in a cohort of 153 patients treated by TACE using the HAP score with a cut-off value of: 0 (HAP A) vs 1 (HAP B) vs 2 (HAP C) vs > 2 (HAP D)

HAP	HAP A(n = 46)	HAP B(n = 43)	HAP C(n = 49)	HAP D(n = 15)
Median-survival, mo (95%CI)	31 (25-37)	31 (20-51)	22 (17-25)	18 (6-32)
P value	0.0454

HAP: Hepatoma arterial-embolization prognostic; TACE: Transarterial chemoembolization.

Table 2 Baseline patients and disease characteristics in three sets (%)

Characteristics	Cohort 1(n =139)	Cohort 2(n = 82)	Cohort 3(n = 100)
Age, median, yr (95%CI)	67 (65-68)	63 (60-69)	68.5 (66-71)
Sex, M/F	84/16	90/10	88/12
Cirrhosis or advanced fibrosis (F3)	100	100	94
Aetiology: Virus/alcohol/virus + alcohol/ NASH	47/35/6/10	49/29/9/7	27/46/6/8
Child-Pugh score: A/B	69/31	75/25	95/5
BCLC A/B/C	47/34/19	34/46/20	10/81/9
Infiltrative tumours	17	22	2
Segmental portal vein thrombosis	15	19.5	9
AFP < 200 ng/mL	78	60	77
AFP ≥ 200 ng/mL	22	40	23
Diagnosis based on: Imaging/ biopsy	85/15	77/23	80/20
Incidental/screening/symptoms	17/70/13	31/53/16	19/66/15
Previous treatments (surgery, RFA)	15	15	18

NASH: Non-alcoholic steatohepatitis; BCLC: Barcelona Clinic Liver Cancer; AFP: α-fetoprotein; RFA: Radiofrequency ablation.

Table 3 Overall survival in the first cohort of patients using the ART score calculated before the second transarterial chemoembolisation with a cut-off value of: 0-1.5 vs≥ 2.5

ART(n = 139)	ART[0](n = 67)	ART[1](n = 11)	ART[1.5](n = 18)	ART[2.5](n = 3)	ART[3](n = 2)	ART[4](n = 16)	ART[5](n = 5)	ART[5.5](n = 5)	ART[6.5](n = 3)	ART[7](n = 2)	ART[8](n = 7)
Median-survival, mo (95%CI)	37 (31-42)	9 (7-14)	28 (25-40)	10 (5-27)	17 (12-21)	28 (7-36)	14 (12-16)	13 (6-15)	5 (3-5)	22 (8-36)	5 (4-11)
	34 (28-38)			13 (10-16)
P value ART (0, 1.5) vs ART ≥ 2.5	< 0.0001

TACE: Transarterial chemoembolization; ART: Assessment for retreatment with TACE.

Table 4 Overall survival in the second cohort of patients using the ART score calculated before the second TACE with a cut-off value of: 0-1.5 vs≥ 2.5

ART(n = 82)	ART[0](n = 39)	ART[1](n = 14)	ART[1.5](n = 5)	ART[2.5](n = 1)	ART[3](n = 3)	ART[4](n = 5)	ART[5](n = 10)	ART[5.5](n = 1)	ART[8](n = 4)
Median-survival,mo (95%CI)	27(22-38)	11(7-18)	15(11-50)	N/A	10(3-31)	31(8-31)	8(7-12)	N/A	8(4-23)
	22 (15-27)			10 (8-23)
Pvalue ART (0, 1.5)vsART≥2.5	0.07

TACE: Transarterial chemoembolization; ART: Assessment for retreatment with TACE.

Table 5 Overallsurvival in the third cohort of patients using the ART score calculated before the second TACE with a cut-off value of: 0-1.5 vs≥ 2.5

ART(n = 100)	ART[0](n = 38)	ART[1](n = 30)	ART[1.5](n = 3)	ART[2.5](n = 8)	ART[4](n = 10)	ART[5](n = 8)	ART[6.5](n = 2)	ART[8](n = 1)
Median-survival, mo (95%CI)	49 (36-63)	21 (17-26)	23 (21-23)	13 (6-15)	24 (19-35)	19 (9-20)	14 (13-15)	9 (-)
	27.4 (24.7-37.8)			15.5 (13.0-23.7)
P value ART (0, 1.5) vs ART ≥ 2.5	0.0001

TACE: Transarterial chemoembolization; ART: Assessment for retreatment with TACE.

Table 6 Overall survival of patients using the ART score calculated before the third TACE with a cut-off value of: 0-1.5 vs≥ 2.5

ART(n = 126)	ART[0](n = 73)	ART[1](n = 12)	ART[1.5](n = 6)	ART[2.5](n = 4)	ART[4](n = 21)	ART[5](n = 2)	ART[6.5](n = 4)	ART[7](n = 2)	ART[8](n = 2)
Median-survival, mo (95%CI)	35 (30-37)	12 (10-18)	34 (27-38)	13 (8-24)	28 (19-41)	21 (9-32)	8 (5-9)	28 (25-31)	6 (4-8)
	31 (27-36)			21 (13-28)
P value ART (0, 1.5) vs ART ≥ 2.5	0.004

TACE: Transarterial chemoembolization; ART: Assessment for retreatment with TACE.

Table 7 Characteristics, median survival, comparative study of patients (first and second cohorts) with an objective radiologic response in both ART ‘groups before the second TACE (%)

Patients with radiologic response	ART (0-1.5)(n = 113)	ART≥2.5(n =28)	P value
AFP < 200 ng/mL	81	82	1.00
AFP ≥ 200 ng/mL	19	18
Child-Pugh A/B	77/23	61/39	0.05
BCLC A/B/C	55/41/4	50/42/8	0.14
Median TACE sessions (95%CI)	3 (3-4)	2 (1-5)	0.17
Median-survival, mo (95%CI)	33 (27-38)	28 (13-35)	0.04
Median follow-up, mo (95%CI)	25 (22-29)	21 (13-31)	0.42

BCLC: Barcelona Clinic Liver Cancer; TACE: Transarterial chemoembolization.