Expected outcomes and patients’ selection before chemoembolization—“Six-and-Twelve or Pre-TACE-Predict” scores may help clinicians: Real-life French cohorts results

ARTICLE HIGHLIGHTS

Research background

Transarterial chemoembolization (TACE) is currently recommended for intermediate stage hepatocellular carcinomas (HCCs), while in practice TACE is performed beyond the recommendations. New therapeutic options in advanced HCC require careful selection of patients prior to TACE treatment, since some patients may not benefit from this therapy and may impair their liver function.

Research motivation

Two recently developed models entitled "pre-TACE-predict” and “Six-and-Twelve” both easy-to-use and powerful, have been designed accordingly, to identify suitable and inappropriate candidates and thus help in the decision-making process.

Research objectives

To evaluate and compare the performance of both new models in survival prediction, and their potential contribution to patient treatment strategy.

Research methods

This is a retrospective multicenter study performed on two French cohorts with HCC of different stages, including 324 patients classified as Barcelona Clinic Liver Cancer (BCLC) stages A/B (cohort 1) and 137 patients classified as BCLC stages B/C (cohort 2), respectively. All of these patients (treatment naïve or with recurrence after curative therapies) received conventional TACE treatment as the main therapy during a period from 01/2010 to 12/2018. Survival prediction was calculated based on these two new models and compared to the BCLC system and established prognostic scores [Albumin-Bilirubin grade, NIACE (Number of tumor, Infiltrative HCC, Child-Pugh, Alpha-fetoprotein, Eastern Cooperative Oncology Group Performance Status)] using concordance-index and area under the receiver operating characteristic curve across time.

Research results

The "pre-TACE-predict" model identified three rather than four groups of patients with different prognosis within a recommended TACE candidate cohort (cohort 1), similar to the “6 and 12” model. Its prognostic value was no higher than other systems, as opposed to the "post-TACE-predict" model that includes response to treatment. The contribution of both new models was reduced in our second cohort with advanced stage HCCs (cohort 2), as prognosis is influenced by variables other than tumor size or number and TACE efficacy is unclear in HCC with vascular invasion.

Research conclusions

Both “pre-TACE-predict” and “6 and 12” models offer an interesting stratification into three groups in a recommended TACE population, by defining respectively a first group with durable control but prone to recurrence, a second partially controlled group prone to progression and a third group that do not benefit from this treatment.

Research perspectives

With further refinement prior to chemoembolization, the “6 and 12” and “pre-TACE-predict” models allow us to consider the future scenarios of TACE therapy with (1) HCC patients who might benefit from adjuvant therapy to prevent recurrence (after a complete response to TACE); (2) others who might benefit from a combined therapy following a partial response to TACE; and (3) others who should be treated with a systemic exclusive therapy.