Transarterial chemo-embolisation of hepatocellular carcinoma: impact of liver function and vascular invasion
Waked I (1), Berhane S (2), Toyoda H (3), Chan SL (4), Stern N (5), Palmer D (2), Tada T (3), Yeo W (6), Mo F (6), Bettinger D (7), Kirstein MM (8), Iñarrairaegui M (9), Gomaa A 1, Vogel A (8), Meyer T (10), Sangro B (9), Lai P (11), Kumada T (3), Johnson PJ (2,12). (1) Department of Hepatology, National Liver Institute, Menoufeya University, Menoufia Governorate, Egypt.
(2) Department of Molecular and Clinical Cancer Medicine, University of Liverpool, The Sherrington Building, Ashton Street, Liverpool L69 3GA, UK.
(3) Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu 503-8052, Japan.
(4) Department of Anatomical & Cellular Pathology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China.
(5) Digestive Diseases Unit, Aintree University Hospitals NHS Foundation Trust, University Hospital Aintree, Liverpool, UK.
(6) State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China.
(7) Department of Internal Medicine II, University Hospital Freiburg, Hugstetter Street 55, Freiburg D-79106, Germany.
(8) Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Carl Neuberg Street 1, Hannover 30625, Germany.
(9) Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra; and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Pamplona, Spain.
(10) Department of Oncology, UCL Cancer Institute, University College London, London, UK.
(11) Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
(12) The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, Wirral CH63 4JY, UK.
Transarterial chemo-embolisation (TACE) is recommended for patients with BCLC intermediate stage hepatocellular carcinoma (stage B), particularly in patients with good underlying liver function and minimal symptoms.
The hepatoma arterial embolisation prognostic (HAP) score combines measures of liver function and tumour-related factors to offer a simple prognostic scoring system. The Albumin-Bilirubin (ALBI) grade permits assessment of the impact of liver function on survival. We aimed to investigate these two models and vascular invasion (VI).
In an international cohort of 3030 patients undergoing TACE, we examined the impact of liver function as assessed by the ALBI score, the HAP score and VI on survival.
Classification according to ALBI grade resulted in non-overlapping survival curves in the overall data set and all regional cohorts. The HAP score was also validated. Tumour number, aetiology and VI were identified as additional independent prognostic risk factors not currently included in the HAP score. Survival was particularly poor for patients with VI.
The ALBI grade categorised patients receiving TACE into three clear prognostic groups, thereby emphasising the importance of underlying liver function in the outcome of TACE. The HAP score has been validated internationally and the serious adverse impact of VI is clearly shown.
CITATION Br J Cancer. 2017 Feb 14;116(4):448-454. doi: 10.1038/bjc.2016.423. Epub 2017 Jan 26