Clinical Research Papers:

Combined sequential use of HAP and ART scores to predict survival outcome and treatment failure following chemoembolization in hepatocellular carcinoma: a multi-center comparative study

David J. Pinato _, Tadaaki Arizumi, Jeong Won Jang, Elias Allara, Puvan I. Suppiah, Carlo Smirne, Paul Tait, Madhava Pai, Glenda Grossi, Young Woon Kim, Mario Pirisi, Masatoshi Kudo and Rohini Sharma

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Oncotarget. 2016; 7:44705-44718. https://doi.org/10.18632/oncotarget.9604

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David J. Pinato1, Tadaaki Arizumi2, Jeong Won Jang3, Elias Allara4,5, Puvan I. Suppiah1, Carlo Smirne4, Paul Tait6, Madhava Pai7, Glenda Grossi4, Young Woon Kim3, Mario Pirisi4,8, Masatoshi Kudo2, Rohini Sharma1

1Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK

2Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan

3Department of Internal Medicine, The Catholic University of Korea Incheon St. Mary’s Hospital, Seoul, Republic of Korea

4Department of Translational Medicine, Università degli Studi del Piemonte Orientale “A. Avogadro”, Novara, Italy

5School of Public Health, Università degli Studi di Torino, Torino, Italy

6Department of Radiology, Imperial College NHS Trust, Hammersmith Hospital, London, UK

7Department of Surgery, Imperial College NHS Trust, Hammersmith Hospital, London, UK

8Interdisciplinary Research Center of Autoimmune Diseases, Università degli Studi del Piemonte Orientale “A. Avogadro”, Novara, Italy

Correspondence to:

David James Pinato, email: david.pinato@imperial.ac.uk

Keywords: prognosis, hepatocellular carcinoma, TACE, ART score, HAP score

Received: February 22, 2016     Accepted: April 26, 2016     Published: May 26, 2016


Background: The prognosis of patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE) is variable, despite a myriad of prognostic markers. We compared and integrated the established prognostic models, HAP and ART scores, for their accuracy of overall survival (OS) prediction.

Results: In both training and validation sets, HAP and ART scores emerged as independent predictors of OS (p<0.01) with HAP achieving better prognostic accuracy (c-index: 0.68) over ART (0.57). We tested both scores in combination to evaluate their combined ability to predict OS. Subgroup analysis of BCLC-C patients revealed favorable HAP stage (p<0.001) and radiological response after initial TACE (p<0.001) as positive prognostic factors.

Patients and Methods: Prognostic scores were studied using multivariable Cox regression and c-index analysis in 83 subjects with Barcelona Clinic Liver Cancer (BCLC) A/B stage from UK and Italy (training set), and 660 from Korea and Japan (validation set), all treated with conventional TACE. Scores were further validated in an separate analysis of patients with BCLC-C stage disease (n=63) receiving initial TACE.

Conclusion: ART and HAP scores are validated indices in patients with intermediate stage HCC undergoing TACE. The HAP score is best suited for screening patients prior to initial TACE, whilst sequential ART assessment improves early detection of chemoembolization failure. BCLC-C patients with low HAP stage may be a subgroup where TACE should be explored in clinical studies.

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