Prognostic Score May Better Stratify Candidates for TACE

Researchers have developed a prognostic score that can help to stratify candidates for transarterial chemoembolization (TACE), according to a study published in the Journal of Hepatology.

“There lacks a prognostic model specifically developed for recommended or ideal TACE candidates with HCC (BCLC-A/B), despite that these patients have been frequently identified as the best target population for TACE in pivotal randomized controlled trials,” the authors stated.

The study included 1,604 treatment-naïve patients with unresectable hepatocellular carcinoma (HCC) undergoing TACE. Patients had Child-Pugh A5-B7 and performance status 0. Data were included from 24 tertiary centers, and patients were randomized to either the training or validation group. Based on these data, the investigators developed and validated a prognostic model and then compared its predictive performance and discrimination with that of other models.

The model with the best performance was "linear predictor = largest tumour diameter (cm) + tumour number.” Cut-off values of 6 and 12 (the 30th percentile and the third quartile of the linear predictor) were chosen, leading investigators to dub the model the “six-and-twelve” score. Using this model, patients can be categorized into 3 strata with the sum of tumor size and number ≤6, >6 but ≤12, and >12. These different categories have median survival of 49.1  months, 32.0 months, and 15.8 months, respectively.

Although further external validations of the score are needed, the authors assert that the score could help stratify patients in clinical practice and could also assist in designing clinical trials with comparable criteria.

The six-and-twelve score provides patient survival prediction especially in ideal candidates of TACE, outperforming other currently available models in both training and validation sets as well as different subgroups,” the authors stated.

Reference

Wang Q, Xia D, Bai W, et al. Development of a prognostic score for recommended TACE candidates with hepatocellular carcinoma: a multicenter observational study. J Hepatol. 2019 Jan 18. pii: S0168-8278(19)30025-X. doi: 10.1016/j.jhep.2019.01.013. [Epub ahead of print]