Prediction of Survival Among Patients Receiving Transarterial Chemoembolization for Hepatocellular Carcinoma: A Response‐Based Approach

Background and Aims The heterogeneity of intermediate‐stage hepatocellular carcinoma (HCC) and the widespread use of transarterial chemoembolization (TACE) outside recommended guidelines have encouraged the development of scoring systems that predict patient survival. The aim of this study was to bu...

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Vydáno v:	Hepatology (Baltimore, Md.) Ročník 72; číslo 1; s. 198 - 212
Hlavní autoři:	Han, Guohong, Berhane, Sarah, Toyoda, Hidenori, Bettinger, Dominik, Elshaarawy, Omar, Chan, Anthony W. H., Kirstein, Martha, Mosconi, Cristina, Hucke, Florian, Palmer, Daniel, Pinato, David J., Sharma, Rohini, Ottaviani, Diego, Jang, Jeong W., Labeur, Tim A., Delden, Otto M., Pirisi, Mario, Stern, Nick, Sangro, Bruno, Meyer, Tim, Fateen, Waleed, García‐Fiñana, Marta, Gomaa, Asmaa, Waked, Imam, Rewisha, Eman, Aithal, Guru P., Travis, Simon, Kudo, Masatoshi, Cucchetti, Alessandro, Peck‐Radosavljevic, Markus, Takkenberg, R.B., Chan, Stephen L., Vogel, Arndt, Johnson, Philip J.
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Wolters Kluwer Health, Inc 01.07.2020 John Wiley and Sons Inc
Témata:	Adult Aged Arteries Bilirubin Carcinoma, Hepatocellular - mortality Carcinoma, Hepatocellular - therapy Chemoembolization Chemoembolization, Therapeutic - methods Cohort Studies Embolization Female Hepatocellular carcinoma Hepatology Hepatoma Humans Liver cancer Liver Neoplasms - mortality Liver Neoplasms - therapy Male Mathematical models Middle Aged Models, Statistical Original Prognosis Solid tumors Statistical analysis Survival Survival Rate
ISSN:	0270-9139, 1527-3350, 1527-3350
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Abstract	Background and Aims The heterogeneity of intermediate‐stage hepatocellular carcinoma (HCC) and the widespread use of transarterial chemoembolization (TACE) outside recommended guidelines have encouraged the development of scoring systems that predict patient survival. The aim of this study was to build and validate statistical models that offer individualized patient survival prediction using response to TACE as a variable. Approach and Results Clinically relevant baseline parameters were collected for 4,621 patients with HCC treated with TACE at 19 centers in 11 countries. In some of the centers, radiological responses (as assessed by modified Response Evaluation Criteria in Solid Tumors [mRECIST]) were also accrued. The data set was divided into a training set, an internal validation set, and two external validation sets. A pre‐TACE model (“Pre‐TACE‐Predict”) and a post‐TACE model (“Post‐TACE‐Predict”) that included response were built. The performance of the models in predicting overall survival (OS) was compared with existing ones. The median OS was 19.9 months. The factors influencing survival were tumor number and size, alpha‐fetoprotein, albumin, bilirubin, vascular invasion, cause, and response as assessed by mRECIST. The proposed models showed superior predictive accuracy compared with existing models (the hepatoma arterial embolization prognostic score and its various modifications) and allowed for patient stratification into four distinct risk categories whose median OS ranged from 7 months to more than 4 years. Conclusions A TACE‐specific and extensively validated model based on routinely available clinical features and response after first TACE permitted patient‐level prognostication.
AbstractList	The heterogeneity of intermediate-stage hepatocellular carcinoma (HCC) and the widespread use of transarterial chemoembolization (TACE) outside recommended guidelines have encouraged the development of scoring systems that predict patient survival. The aim of this study was to build and validate statistical models that offer individualized patient survival prediction using response to TACE as a variable.BACKGROUND AND AIMSThe heterogeneity of intermediate-stage hepatocellular carcinoma (HCC) and the widespread use of transarterial chemoembolization (TACE) outside recommended guidelines have encouraged the development of scoring systems that predict patient survival. The aim of this study was to build and validate statistical models that offer individualized patient survival prediction using response to TACE as a variable.Clinically relevant baseline parameters were collected for 4,621 patients with HCC treated with TACE at 19 centers in 11 countries. In some of the centers, radiological responses (as assessed by modified Response Evaluation Criteria in Solid Tumors [mRECIST]) were also accrued. The data set was divided into a training set, an internal validation set, and two external validation sets. A pre-TACE model ("Pre-TACE-Predict") and a post-TACE model ("Post-TACE-Predict") that included response were built. The performance of the models in predicting overall survival (OS) was compared with existing ones. The median OS was 19.9 months. The factors influencing survival were tumor number and size, alpha-fetoprotein, albumin, bilirubin, vascular invasion, cause, and response as assessed by mRECIST. The proposed models showed superior predictive accuracy compared with existing models (the hepatoma arterial embolization prognostic score and its various modifications) and allowed for patient stratification into four distinct risk categories whose median OS ranged from 7 months to more than 4 years.APPROACH AND RESULTSClinically relevant baseline parameters were collected for 4,621 patients with HCC treated with TACE at 19 centers in 11 countries. In some of the centers, radiological responses (as assessed by modified Response Evaluation Criteria in Solid Tumors [mRECIST]) were also accrued. The data set was divided into a training set, an internal validation set, and two external validation sets. A pre-TACE model ("Pre-TACE-Predict") and a post-TACE model ("Post-TACE-Predict") that included response were built. The performance of the models in predicting overall survival (OS) was compared with existing ones. The median OS was 19.9 months. The factors influencing survival were tumor number and size, alpha-fetoprotein, albumin, bilirubin, vascular invasion, cause, and response as assessed by mRECIST. The proposed models showed superior predictive accuracy compared with existing models (the hepatoma arterial embolization prognostic score and its various modifications) and allowed for patient stratification into four distinct risk categories whose median OS ranged from 7 months to more than 4 years.A TACE-specific and extensively validated model based on routinely available clinical features and response after first TACE permitted patient-level prognostication.CONCLUSIONSA TACE-specific and extensively validated model based on routinely available clinical features and response after first TACE permitted patient-level prognostication. The heterogeneity of intermediate-stage hepatocellular carcinoma (HCC) and the widespread use of transarterial chemoembolization (TACE) outside recommended guidelines have encouraged the development of scoring systems that predict patient survival. The aim of this study was to build and validate statistical models that offer individualized patient survival prediction using response to TACE as a variable. Clinically relevant baseline parameters were collected for 4,621 patients with HCC treated with TACE at 19 centers in 11 countries. In some of the centers, radiological responses (as assessed by modified Response Evaluation Criteria in Solid Tumors [mRECIST]) were also accrued. The data set was divided into a training set, an internal validation set, and two external validation sets. A pre-TACE model ("Pre-TACE-Predict") and a post-TACE model ("Post-TACE-Predict") that included response were built. The performance of the models in predicting overall survival (OS) was compared with existing ones. The median OS was 19.9 months. The factors influencing survival were tumor number and size, alpha-fetoprotein, albumin, bilirubin, vascular invasion, cause, and response as assessed by mRECIST. The proposed models showed superior predictive accuracy compared with existing models (the hepatoma arterial embolization prognostic score and its various modifications) and allowed for patient stratification into four distinct risk categories whose median OS ranged from 7 months to more than 4 years. A TACE-specific and extensively validated model based on routinely available clinical features and response after first TACE permitted patient-level prognostication. Background and AimsThe heterogeneity of intermediate‐stage hepatocellular carcinoma (HCC) and the widespread use of transarterial chemoembolization (TACE) outside recommended guidelines have encouraged the development of scoring systems that predict patient survival. The aim of this study was to build and validate statistical models that offer individualized patient survival prediction using response to TACE as a variable.Approach and ResultsClinically relevant baseline parameters were collected for 4,621 patients with HCC treated with TACE at 19 centers in 11 countries. In some of the centers, radiological responses (as assessed by modified Response Evaluation Criteria in Solid Tumors [mRECIST]) were also accrued. The data set was divided into a training set, an internal validation set, and two external validation sets. A pre‐TACE model (“Pre‐TACE‐Predict”) and a post‐TACE model (“Post‐TACE‐Predict”) that included response were built. The performance of the models in predicting overall survival (OS) was compared with existing ones. The median OS was 19.9 months. The factors influencing survival were tumor number and size, alpha‐fetoprotein, albumin, bilirubin, vascular invasion, cause, and response as assessed by mRECIST. The proposed models showed superior predictive accuracy compared with existing models (the hepatoma arterial embolization prognostic score and its various modifications) and allowed for patient stratification into four distinct risk categories whose median OS ranged from 7 months to more than 4 years.ConclusionsA TACE‐specific and extensively validated model based on routinely available clinical features and response after first TACE permitted patient‐level prognostication. Background and Aims The heterogeneity of intermediate‐stage hepatocellular carcinoma (HCC) and the widespread use of transarterial chemoembolization (TACE) outside recommended guidelines have encouraged the development of scoring systems that predict patient survival. The aim of this study was to build and validate statistical models that offer individualized patient survival prediction using response to TACE as a variable. Approach and Results Clinically relevant baseline parameters were collected for 4,621 patients with HCC treated with TACE at 19 centers in 11 countries. In some of the centers, radiological responses (as assessed by modified Response Evaluation Criteria in Solid Tumors [mRECIST]) were also accrued. The data set was divided into a training set, an internal validation set, and two external validation sets. A pre‐TACE model (“Pre‐TACE‐Predict”) and a post‐TACE model (“Post‐TACE‐Predict”) that included response were built. The performance of the models in predicting overall survival (OS) was compared with existing ones. The median OS was 19.9 months. The factors influencing survival were tumor number and size, alpha‐fetoprotein, albumin, bilirubin, vascular invasion, cause, and response as assessed by mRECIST. The proposed models showed superior predictive accuracy compared with existing models (the hepatoma arterial embolization prognostic score and its various modifications) and allowed for patient stratification into four distinct risk categories whose median OS ranged from 7 months to more than 4 years. Conclusions A TACE‐specific and extensively validated model based on routinely available clinical features and response after first TACE permitted patient‐level prognostication.
Author	Travis, Simon Chan, Stephen L. Meyer, Tim Gomaa, Asmaa Labeur, Tim A. Pinato, David J. Delden, Otto M. Sangro, Bruno Aithal, Guru P. Mosconi, Cristina Jang, Jeong W. Bettinger, Dominik Berhane, Sarah Chan, Anthony W. H. Takkenberg, R.B. Elshaarawy, Omar Waked, Imam Kudo, Masatoshi Ottaviani, Diego Stern, Nick Peck‐Radosavljevic, Markus Toyoda, Hidenori Sharma, Rohini Fateen, Waleed Hucke, Florian Johnson, Philip J. García‐Fiñana, Marta Palmer, Daniel Rewisha, Eman Cucchetti, Alessandro Han, Guohong Pirisi, Mario Vogel, Arndt Kirstein, Martha
AuthorAffiliation	4 Department of Medicine II Faculty of Medicine Medical Center University of Freiburg University of Freiburg Freiburg Germany 22 Department of Radiology Nottingham University Hospitals National Health Service Trust Nottingham United Kingdom 21 Nottingham Digestive Diseases Centre School of Medicine University of Nottingham Nottingham United Kingdom 17 Department of Gastroenterology and Hepatology Aintree University Hospital Liverpool United Kingdom 18 Liver Unit Clínica Universidad de Navarra IDISNA and CIBEREHD Pamplona Spain 14 Department of Gastroenterology and Hepatology Amsterdam University Medical Center Amsterdam the Netherlands 24 Department of Medical and Surgical Sciences University of Bologna Bologna Italy 8 Radiology Unit Department of Specialized Diagnostic and Experimental Medicine Alma Mater Studiorum ‐ University of Bologna Italy University Hospital of Bologna Sant'Orsola‐Malpighi Polyclinic Bologna Italy 11 Department of Surgery and Cancer Imperial College London London United
AuthorAffiliation_xml	– name: 7 Department of Gastroenterology, Hepatology and Endocrinology Hannover Medical School Hannover Germany – name: 25 Department of Clinical Oncology Chinese University of Hong Kong Shatin Hong Kong – name: 4 Department of Medicine II Faculty of Medicine Medical Center University of Freiburg University of Freiburg Freiburg Germany – name: 9 Department of Internal Medicine and Gastroenterology Klinikum Klagenfurt am Wörthersee Klagenfurt Austria – name: 6 Department of Pathology Chinese University of Hong Kong Hong Kong – name: 8 Radiology Unit Department of Specialized Diagnostic and Experimental Medicine Alma Mater Studiorum ‐ University of Bologna Italy University Hospital of Bologna Sant'Orsola‐Malpighi Polyclinic Bologna Italy – name: 18 Liver Unit Clínica Universidad de Navarra IDISNA and CIBEREHD Pamplona Spain – name: 22 Department of Radiology Nottingham University Hospitals National Health Service Trust Nottingham United Kingdom – name: 24 Department of Medical and Surgical Sciences University of Bologna Bologna Italy – name: 13 Department of Internal Medicine The Catholic University of Korea Seoul St. Mary’s Hospital Seoul Republic of Korea – name: 21 Nottingham Digestive Diseases Centre School of Medicine University of Nottingham Nottingham United Kingdom – name: 15 Department of Radiology Amsterdam University Medical Centers Amsterdam the Netherlands – name: 20 National Institute for Health Research Nottingham Biomedical Research Centre Nottingham University Hospitals National Health Service Trust and the University of Nottingham Nottingham United Kingdom – name: 11 Department of Surgery and Cancer Imperial College London London United Kingdom – name: 14 Department of Gastroenterology and Hepatology Amsterdam University Medical Center Amsterdam the Netherlands – name: 23 Department of Gastroenterology and Hepatology Kinki University School of Medicine Osaka‐Sayama Osaka Japan – name: 12 UCL Cancer Institute University College London London United Kingdom – name: 19 Research Department of Oncology UCL Cancer Institute University College London London United Kingdom – name: 16 Department of Translational Medicine Università del Piemonte Orientale Novara Italy – name: 5 National Liver Institute Menoufia University Shebeen El‐Kom Egypt – name: 1 Department of Liver Disease and Digestive Interventional Radiology Xijing Hospital of Digestive Disease Fourth Military Medical University Xi’an China – name: 10 Department of Molecular and Clinical Cancer Medicine University of Liverpool Liverpool United Kingdom – name: 17 Department of Gastroenterology and Hepatology Aintree University Hospital Liverpool United Kingdom – name: 2 Department of Biostatistics University of Liverpool Liverpool United Kingdom – name: 3 Department of Gastroenterology and Hepatology Ogaki Municipal Hospital Ogaki Japan
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BackLink	https://www.ncbi.nlm.nih.gov/pubmed/31698504$$D View this record in MEDLINE/PubMed
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Copyright	2020 The Authors. Hepatology published by Wiley Periodicals, Inc., on behalf of American Association for the Study of Liver Diseases. 2020. This article is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.
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License	Attribution 2020 The Authors. Hepatology published by Wiley Periodicals, Inc., on behalf of American Association for the Study of Liver Diseases. This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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Notes	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Undefined-3 Previously presented at the International Liver Cancer Association, London, 2018. Funding: Supported by National Natural Science Foundation of China grants (81172145 and 81420108020) for data collection in Xijing Hospital to G.H.; the National Institute for Health Research grant to D.J.P.; the UK Engineering and Physical Sciences Research Council grant (EP/N014499/1) to S.B. and M.G.F.; and the National Institute for Health Research Nottingham Biomedical Research Centre grant (BRC‐1215‐20003) to W.F. Potential conflict of interest: Dr. Toyoda is on the speakers’ bureau for MSD and AbbVie. Dr. Bettinger received grants from Bayer. Dr. Palmer advises and received grants from Bristol‐Myers Squibb, Sirtex, Bayer, Eisai, and AZ. He received grants from BTG. Dr. Pinato consults for ViiV and received grants from Bristol‐Myers Squibb and MSD. Dr. van Delden consults for Coch Medical. Dr. Sangro consults for, is on the speakers’ bureau of, and received grants from Bristol‐Myers Squibb and Sirtex. He consults and is on the speakers’ bureau for Bayer and AZ. He consults for Adaptimmune, BTG, Lilly, Ipsen, and Enxeo. Dr. Meyer consults for and received grants from Bayer and BTG. He consults for Eisai, Bristol‐Myers Squibb, MSD, and Takeda. Dr. Aithal consults for GlaxoSmithKline, Pfizer, and Agios. Dr. Travis advises Guerbet and Boston Scientific. Dr. Kudo advises and received grants from Eisai, Ono, MSD, and Bristol‐Myers Squibb. He advises Bayer and Eli Lilly and received grants from AbbVie, Takeda, Gilead, Otsuka, and Taiho. Dr. Takkenberg advises and is on the speakers’ bureau for Norgine. He advises Gilead, is on the speakers’ bureau for Gore and Bayer, and received grants from GastroStart and ZonMw.
ORCID	0000-0003-3255-8474 0000-0003-4568-3776 0000-0002-1771-163X 0000-0002-8782-8729
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PublicationDate	July 2020
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PublicationTitle	Hepatology (Baltimore, Md.)
PublicationTitleAlternate	Hepatology
PublicationYear	2020
Publisher	Wolters Kluwer Health, Inc John Wiley and Sons Inc
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References	2015; 13 2011; 258 2015; 15 2017; 41 2017; 4 2013; 24 2017; 66 2002; 35 2015; 33 2002; 359 2011; 53 2003; 37 2011; 34 2017; 29 2018; 67 2012; 35 2012; 56 2014; 61 2016; 36 2017; 116 2018; 69 2015; 45 2010; 21 2013; 57 2013; 13 2017; 17 2015; 62 2015; 63 2016; 64 2018 2012; 24 2014; 7 2016; 48 2010; 30 2007; 46 (hep31022-bib-0001-20241017) 2018; 69 (hep31022-bib-0039-20241017) 2015; 62 (hep31022-bib-0002-20241017) 2018; 67 (hep31022-bib-0012-20241017) 2013; 57 (hep31022-bib-0040-20241017) 2015; 45 (hep31022-bib-0036-20241017) 2012; 24 (hep31022-bib-0037-20241017) 2007; 46 (hep31022-bib-0004-20241017) 2002; 35 (hep31022-bib-0023-20241017) 2015; 13 (hep31022-bib-0029-20241017) 2016; 64 (hep31022-bib-0026-20241017) 2015; 15 (hep31022-bib-0038-20241017) 2014; 7 (hep31022-bib-0035-20241017) 2015; 62 (hep31022-bib-0015-20241017) 2016; 36 (hep31022-bib-0022-20241017) 2017; 66 (hep31022-bib-0021-20241017) 2017; 66 (hep31022-bib-0043-20241017) 2017; 4 (hep31022-bib-0024-20241017) 2015; 33 (hep31022-bib-0009-20241017) 2016; 64 (hep31022-bib-0016-20241017) 2015; 13 (hep31022-bib-0005-20241017) 2012; 56 (hep31022-bib-0006-20241017) 2012; 35 (hep31022-bib-0027-20241017) 2010; 21 (hep31022-bib-0030-20241017) 2015; 63 (hep31022-bib-0003-20241017) 2002; 359 (hep31022-bib-0013-20241017) 2013; 24 (hep31022-bib-0017-20241017) 2015; 33 (hep31022-bib-0025-20241017) 2013; 13 (hep31022-bib-0014-20241017) 2016; 36 (hep31022-bib-0010-20241017) 2011; 34 (hep31022-bib-0011-20241017) 2011; 258 (hep31022-bib-0018-20241017) 2018 (hep31022-bib-0041-20241017) 2017; 41 (hep31022-bib-0034-20241017) 2016; 36 (hep31022-bib-0020-20241017) 2010; 30 (hep31022-bib-0019-20241017) 2017; 116 (hep31022-bib-0031-20241017) 2011; 53 (hep31022-bib-0033-20241017) 2016; 36 (hep31022-bib-0028-20241017) 2017; 17 (hep31022-bib-0008-20241017) 2014; 61 (hep31022-bib-0007-20241017) 2003; 37 (hep31022-bib-0042-20241017) 2016; 48 (hep31022-bib-0032-20241017) 2017; 29
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responses at early time point by contrast‐enhanced dynamic MRI predict survival in patients with unresectable hepatocellular carcinoma (HCC) treated by doxorubicin drug‐eluting beads transarterial chemoembolization (DEB TACE) publication-title: Ann Oncol – volume: 53 start-page: 1580 year: 2011 ident: hep31022-bib-0031-20241017 article-title: Efficacy of selective transarterial chemoembolization in inducing tumor necrosis in small (<5 cm) hepatocellular carcinomas publication-title: Hepatology doi: 10.1002/hep.24246 – volume: 13 start-page: 33 year: 2013 ident: hep31022-bib-0025-20241017 article-title: External validation of a Cox prognostic model: principles and methods publication-title: BMC Med Res Methodol doi: 10.1186/1471-2288-13-33 – volume: 56 start-page: 1330 year: 2012 ident: hep31022-bib-0005-20241017 article-title: Survival of patients with hepatocellular carcinoma treated by transarterial chemoembolisation (TACE) using drug eluting beads. Implications for clinical practice and trial design publication-title: J Hepatol doi: 10.1016/j.jhep.2012.01.008 – volume: 46 start-page: 474 year: 2007 ident: hep31022-bib-0037-20241017 article-title: Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics publication-title: J Hepatol doi: 10.1016/j.jhep.2006.10.020 – volume: 63 start-page: 122 year: 2015 ident: hep31022-bib-0030-20241017 article-title: Prognostic nomogram for patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolization publication-title: J Hepatol doi: 10.1016/j.jhep.2015.02.034 – volume: 64 start-page: 23 year: 2016 ident: hep31022-bib-0009-20241017 article-title: Lipiodol transarterial chemoembolization for hepatocellular carcinoma: where are we now? publication-title: Hepatology doi: 10.1002/hep.28554 – volume: 116 start-page: 448 year: 2017 ident: hep31022-bib-0019-20241017 article-title: Transarterial chemo‐embolisation of hepatocellular carcinoma: impact of liver function and vascular invasion publication-title: Br J Cancer doi: 10.1038/bjc.2016.423 – volume: 36 start-page: 100 year: 2016 ident: hep31022-bib-0033-20241017 article-title: Addition of tumor multiplicity improves the prognostic performance of the hepatoma arterial‐embolization prognostic score publication-title: Liver Int doi: 10.1111/liv.12878 – volume: 62 start-page: 1002 year: 2015 ident: hep31022-bib-0039-20241017 article-title: Meta‐analysis of doxorubicin‐eluting beads via transcatheter arterial chemoembolization in the treatment of unresectable hepatocellular carcinoma publication-title: Hepatogastroenterology
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Snippet	Background and Aims The heterogeneity of intermediate‐stage hepatocellular carcinoma (HCC) and the widespread use of transarterial chemoembolization (TACE)... The heterogeneity of intermediate-stage hepatocellular carcinoma (HCC) and the widespread use of transarterial chemoembolization (TACE) outside recommended... Background and AimsThe heterogeneity of intermediate‐stage hepatocellular carcinoma (HCC) and the widespread use of transarterial chemoembolization (TACE)...
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SubjectTerms	Adult Aged Arteries Bilirubin Carcinoma, Hepatocellular - mortality Carcinoma, Hepatocellular - therapy Chemoembolization Chemoembolization, Therapeutic - methods Cohort Studies Embolization Female Hepatocellular carcinoma Hepatology Hepatoma Humans Liver cancer Liver Neoplasms - mortality Liver Neoplasms - therapy Male Mathematical models Middle Aged Models, Statistical Original Prognosis Solid tumors Statistical analysis Survival Survival Rate
Title	Prediction of Survival Among Patients Receiving Transarterial Chemoembolization for Hepatocellular Carcinoma: A Response‐Based Approach
URI	https://onlinelibrary.wiley.com/doi/abs/10.1002%2Fhep.31022 https://www.ncbi.nlm.nih.gov/pubmed/31698504 https://www.proquest.com/docview/2423589985 https://www.proquest.com/docview/2313361314 https://pubmed.ncbi.nlm.nih.gov/PMC7496334
Volume	72
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