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Prediction of Survival Among Patients Receiving Transarterial Chemoembolization for Hepatocellular Carcinoma: A Response-Based Approach
- Source :
- Hepatology (Baltimore, Md.), 72(1), 198-212. John Wiley and Sons Ltd, Hepatology (Baltimore, Md.)
- Publication Year :
- 2019
-
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 19.9months. 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 7months to more than 4years. Conclusions: A TACE-specific and extensively validated model based on routinely available clinical features and response after first TACE permitted patient-level prognostication.
- Subjects :
- 0301 basic medicine
Oncology
Male
EXTERNAL VALIDATION
ARTERIAL CHEMOEMBOLIZATION
Prognostic score
Cohort Studies
0302 clinical medicine
Training set
Liver Neoplasms
hepatocellular carcinoma
Arteries
Middle Aged
EMBOLIZATION
Prognosis
Survival Rate
DRUG-ELUTING BEADS
1101 Medical Biochemistry and Metabolomics
1107 Immunology
Response Evaluation Criteria in Solid Tumors
SAFETY
Hepatocellular carcinoma
Original Article
030211 gastroenterology & hepatology
Female
Life Sciences & Biomedicine
Adult
medicine.medical_specialty
Carcinoma, Hepatocellular
RETREATMENT
mRECIST
survival
03 medical and health sciences
Internal medicine
SCORE
medicine
Overall survival
Humans
Internal validation
Chemoembolization, Therapeutic
Aged
TACE
Science & Technology
Models, Statistical
Gastroenterology & Hepatology
Hepatology
business.industry
External validation
1103 Clinical Sciences
Patient survival
Original Articles
EFFICACY
medicine.disease
030104 developmental biology
LIVER-FUNCTION
business
Subjects
Details
- ISSN :
- 15273350 and 02709139
- Volume :
- 72
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Hepatology (Baltimore, Md.)
- Accession number :
- edsair.doi.dedup.....7e235f3e5de5f59c23131617875d4c68