A refined prediction model for survival in hepatocellular carcinoma patients treated with transarterial chemoembolization

Hae Lim Lee; Seok Hwan Kim; Hee Yeon Kim; Sung Won Lee; Myeong Jun Song

doi:10.3389/fonc.2024.1354964

A refined prediction model for survival in hepatocellular carcinoma patients treated with transarterial chemoembolization

Front Oncol. 2024 Mar 28:14:1354964. doi: 10.3389/fonc.2024.1354964. eCollection 2024.

Authors

Hae Lim Lee^{1

2

3}, Seok Hwan Kim^{1

2

3}, Hee Yeon Kim^{1

2

3}, Sung Won Lee^{1

2

3}, Myeong Jun Song^{1

2

3}

Affiliations

¹ Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
² Korean Liver Cancer Study Group, Seoul, Republic of Korea.
³ Ministry of Health and Welfare, Korea Central Cancer Registry, Goyang-si, Gyeonggi-do, Republic of Korea.

Abstract

Background/aims: Transarterial chemoembolization (TACE) is widely performed as a major treatment for hepatocellular carcinoma (HCC) patients, and there is a need to stratify patients for whom the most benefit from the treatment. This study aimed to develop a refined prediction model for overall survival (OS) in patients undergoing TACE as a first-line treatment in a large cohort and validate its performance.

Methods: A total of 2,632 patients with HCC of Barcelona Clinic Liver Cancer stage A or B who underwent TACE between 2008 and 2017 were enrolled. The patients were randomly assigned to a training cohort (n = 1,304) or a validation cohort (n = 1,328). Independent predictors of OS were used to develop a prediction model.

Results: The median age of patients in the entire cohort was 63 years, with the majority having hepatitis B virus (56.6%) and being classified as Child-Pugh class A (82.4%). We developed a new prognostic model, called the TACE-prognostic (TP) score, based on tumor burden (sum of the largest tumor diameter and tumor number), alpha-fetoprotein, and Albumin-Bilirubin grade. Patients were classified into five risk groups according to TP scores, with median survival significantly differentiated in both training and validation cohorts (P < 0.001). The new model consistently outperformed other currently available models in both the training and validation cohorts.

Conclusion: This newly developed TP scoring system has the potential to be a useful tool in identifying ideal candidates of TACE and predicting OS with favorable performance and discrimination. However, further external validation is needed to confirm its effectiveness.

Keywords: hepatocellular carcinoma; overall survival; prediction; transarterial chemoembolization; treatment.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. The author wishes to acknowledge the financial support of the Catholic Medical Center Research Foundation made in the program year of 2022. This work was also supported by The Catholic University of Korea Daejeon St. Mary’s Hospital, Clinical research institute Grant funded by The Catholic University of Korea Daejeon St. Mary’s Hospital (CMCDJ-P-2024-003). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.