评分系统预测肝细胞癌经动脉化疗栓塞治疗结局的适用性。

Applicability of scoring systems predicting outcome of transarterial chemoembolization for hepatocellular carcinoma.

机构信息

Internal Medicine IV, Heidelberg University Hospital, Heidelberg, Germany.

Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, Heidelberg, Germany.

出版信息

J Cancer Res Clin Oncol. 2020 Apr;146(4):1033-1050. doi: 10.1007/s00432-020-03135-8. Epub 2020 Feb 27.

PURPOSE

Several scoring systems have been proposed to predict the outcome of transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC). However, the application of these scores to a bridging to transplant setting is poorly validated. Evaluation of the applicability of prognostic scores for patients undergoing TACE in palliative intention vs. bridging therapy to liver transplantation (LT) is necessary.

METHODS

Between 2008 and 2017, 148 patients with HCC received 492 completed TACE procedures (158 for bridging to transplant; 334 TACE procedures in palliative treatment intention at our center and were analyzed retrospectively. Scores (ART, CLIP, ALBI, APRI, SNACOR, HAP, STATE score, Child-Pugh, MELD, Okuda and BCLC) were calculated and evaluated for prediction of overall survival. ROC analysis was performed to assess prediction of 3-year survival and treatment discontinuation.

RESULTS

In patients receiving TACE in palliative intention most scores predicted OS in univariate analysis but only mSNACOR score (p = 0.006), State score (p < 0.001) and Child-Pugh score (p < 0.001) revealed statistical significance in the multivariate analysis. In the bridging to LT cohort only the BCLC score revealed statistical significance (p = 0.002).

CONCLUSIONS

Clinical usability of suggested scoring systems for TACE might be limited depending on the individual patient cohorts and the indication. Especially in patients receiving TACE as bridging to LT none of the scores showed sufficiently applicability. In our study Child-Pugh score, STATE score and mSNACOR score showed the best performance assessing OS in patients with TACE as palliative therapy.

目的

已经提出了几种评分系统来预测肝细胞癌（HCC）患者经动脉化疗栓塞（TACE）的预后。然而，这些评分在桥接移植中的应用尚未得到充分验证。因此，评估这些评分在姑息性治疗与桥接肝移植（LT）治疗中的适用性是必要的。

方法

2008 年至 2017 年间，148 例 HCC 患者接受了 492 次 TACE 治疗（其中 158 次用于桥接移植；334 次 TACE 治疗用于姑息性治疗），并对这些患者进行回顾性分析。计算了 ART、CLIP、ALBI、APRI、SNACOR、HAP、STATE 评分、Child-Pugh、MELD、Okuda 和 BCLC 等评分，并评估了其对总生存期的预测价值。进行 ROC 分析以评估对 3 年生存率和治疗终止的预测能力。

结果

在接受姑息性 TACE 治疗的患者中，大多数评分在单因素分析中均能预测 OS，但只有 mSNACOR 评分（p=0.006）、STATE 评分（p<0.001）和 Child-Pugh 评分（p<0.001）在多因素分析中具有统计学意义。在桥接 LT 组中，只有 BCLC 评分具有统计学意义（p=0.002）。

结论

根据不同的患者队列和治疗指征，建议的 TACE 评分系统的临床可用性可能会受到限制。特别是在接受 TACE 桥接 LT 的患者中，没有一个评分系统具有足够的适用性。在我们的研究中，Child-Pugh 评分、STATE 评分和 mSNACOR 评分在评估姑息性 TACE 治疗患者的 OS 方面表现最佳。