Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2021; 9(18): 4559-4572
Published online Jun 26, 2021. doi: 10.12998/wjcc.v9.i18.4559
Expected outcomes and patients’ selection before chemoembolization—“Six-and-Twelve or Pre-TACE-Predict” scores may help clinicians: Real-life French cohorts results
Xavier Adhoute, Edouard Larrey, Rodolphe Anty, Patrick Chevallier, Guillaume Penaranda, Albert Tran, Jean-Pierre Bronowicki, Jean-Luc Raoul, Paul Castellani, Hervé Perrier, Olivier Bayle, Olivier Monnet, Bernard Pol, Marc Bourliere
Xavier Adhoute, Paul Castellani, Hervé Perrier, Marc Bourliere, Department of Gastroenterology and Hepatology, Hôpital Saint-Joseph, Marseille 13008, France
Edouard Larrey, Rodolphe Anty, Albert Tran, Department of Gastroenterology and Hepatology, Hôpital Universitaire de l’Archet, Nice 06000, France
Patrick Chevallier, Department of Radiology, Hôpital Universitaire de l’Archet, Nice 06000, France
Guillaume Penaranda, Statistics Department, AlphaBio Laboratory, Marseille 13003, France
Jean-Pierre Bronowicki, Department of Gastroenterology and Hepatology, Centre Hospitalo-Universitaire de Nancy, Vandoeuvre les Nancy 54511, France
Jean-Luc Raoul, Department of Medical Oncology, Institut de Cancérologie de l’Ouest, Site de Nantes, Nantes 44805, France
Olivier Bayle, Olivier Monnet, Department of Radiology, Hôpital Saint-Joseph, Marseille 13008, France
Bernard Pol, Department of Hepatobiliary Surgery, Hôpital Saint-Joseph, Marseille 13008, France
Author contributions: Adhoute X, Larrey E, Tran A, Bourliere M, Anty R, Castellani P, Perrier H, Pol B and Bronowicki JP were the physicians in charge of the patients; Chevallier P, Monnet O and Bayle O were the radiologists who performed endovascular treatments; Adhoute X, Larrey E, Bourliere M and Bronowicki JP collected the data and Penaranda G proceeded to statistical analysis; Adhoute X, Bourliere M, Larrey E, Raoul JL and Anty R wrote the manuscript.
Institutional review board statement: This study did not involve humans, but only the reuse of already recorded data. Since this study was based on a retrospective analysis of clinical data, the Institutional and Ethical Review Board of the Hôpital Saint-Joseph waived requirement for informed patient consent and approved the study.
Informed consent statement: Since this study was based on a retrospective analysis of clinical data, the Institutional Review Board waived requirement for informed patient consent; the Ethics Committee of our institution (Hôpital Saint-Joseph) authorized us to carry out this work.
Conflict-of-interest statement: The authors have no potential conflict of interest relative to this article. Adhoute X: Board member (Bayer, Ipsen, Eisai); Grant from Ipsen, Eisai. Anty R: Board member (Gilead, Bayer, Eisai, Intercept, Abbvie, MSD, Ipsen). Chevallier P: Board member (Bayer). Tran A: Board member (Gilead, Bayer, Eisai, Intercept, Abbvie, MSD, Ipsen). Bronowicki JP: Board member (Merck-Schering Plough, Janssen, Roche, BMS, Boehringer-Ingelheim, Gilead, Novartis, GSK, Bayer). Raoul JL: Board member (Bayer, BMS, Daichi). Castellani P: Board member (Gilead). Bourlière M: Board member (Merck-Schering Plough, Gilead, Janssen, Vertex, Boehringer-Ingelheim, BMS, Roche, Abbvie, GSK). Pénaranda G, Perrier H, Monnet O, Bayle O and Pol B have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
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: Xavier Adhoute, Doctor, Department of Gastroenterology and Hepatology, Hôpital Saint-Joseph, 26 Bd de Louvain, Marseille 13008, France. xvadhoute@gmail.com
Received: November 7, 2020
Peer-review started: November 7, 2020
First decision: December 13, 2020
Revised: December 26, 2020
Accepted: February 4, 2021
Article in press: February 4, 2021
Published online: June 26, 2021
Processing time: 215 Days and 11.6 Hours
Abstract
BACKGROUND

Careful selection of hepatocellular carcinoma (HCC) patients prior to chemoembolization treatment is a daily reality, and is even more necessary with new available therapeutic options in HCC.

AIM

To propose two new models to better stratify patients and maximize clinical benefit: “6 and 12” and “pre/post-TACE-predict” (TACE, transarterial chemoembolization).

METHODS

We evaluated and compared their performance in predicting overall survival with other systems {Barcelona Clinic Liver Cancer (BCLC), Albumin-Bilirubin (ALBI) and NIACE [Number of tumor(s), Infiltrative HCC, alpha-fetoprotein, Child-Pugh (CP), and performance status]} in two HCC French cohorts of different stages enrolled between 2010 and 2018.

RESULTS

The cohorts included 324 patients classified as BCLC stages A/B (cohort 1) and 137 patients classified as BCLC stages B/C (cohort 2). The majority of the patients had cirrhosis with preserved liver function. “Pre-TACE-predict” and “6 and 12” models identified three distinct categories of patients exhibiting different prognosis in cohort 1. However, their prognostic value was no better than the BCLC system or NIACE score. Liver function based on CP and ALBI grades significantly impacted patient survival. Conversely, the “post-TACE-predict” model had a higher predictive value than other models. The stratification ability as well as predictive performance of these new models in an intermediate/advanced stage population was less efficient (cohort 2).

CONCLUSION

The newly proposed “Pre-TACE-predict” and “6 and 12” models offer an interesting stratification into three categories in a recommended TACE population, as they identify poor candidates, those with partial control and durable response. The models' contribution was reduced in a population with advanced stage HCCs.

Keywords: Hepatocellular carcinoma; Transarterial chemoembolization; Pre-TACE-predict; Six-and-twelve; Barcelona Clinic Liver Cancer; Prognosis

Core Tip: Management of hepatocellular carcinoma (HCC) has significantly changed over the past few years. The introduction of new systemic therapies, including immune checkpoint inhibitors has improved survival, especially in patients with advanced stage HCC. Careful selection of patients prior to transarterial chemoembolization (TACE) is crucial. “Up-to-seven criteria” have been proposed for subclassification of intermediate stages. More recently, two models (“6 and 12”; “pre-TACE-predict”) have been developed to improve patient stratification and refine prognosis, overcoming the limitations of points-based scores. In this retrospective multi-center French study, we evaluated and compared these two new models to validate their prognostic value and applicability in clinical current practice.