Aparato Digestivo, Hospital Universitario de Cabueñes.
Gastroenterology and Hepatology, Hospital Universitario Central de Asturias.
Rev Esp Enferm Dig. 2022 Jan;114(1):28-34. doi: 10.17235/reed.2021.7696/2020.
The effectiveness of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) depends on the selection of suitable patients. The ''Six-and-twelve score" distinguishes three groups of ideal patients with different overall survival, based on the sum of the number and size of tumors. This may impact on clinical practice and trial design. The aim of this study was to assess the reproducibility and prognostic value of the model in western patients treated with Drug-Eluting Beads (DEB)-TACE.
Observational, retrospective, unicentric study with consecutive compensated patients treated with DEB-TACE from October 2008 to October 2017. Exclusion criteria were Child-Pugh ≥ 8 and DEB-TACE used as a bridge to liver transplantation.
225 HCC consecutive patients were included; BCLC-0/A n=131 (single nodules > 5, n=29) and BCLC-B n=94. The median overall survival (OS) was 27 months (95% CI 23.8-30.2). OS was different between BCLC-0/A vs BCLC-B: 30 vs 24 months (p= 0.03), Child-Pugh A5 vs A6-B7: 30 vs 27 months (p= 0.003). ''Six-and-twelve score" groups discriminated OS: group 1, n=123, 32 months (95% CI 27.5-63.5), group 2, n=101, 24 months (95% CI 19.6-28.4) and group 3, n=1, 27 months (p=0.024). When comparing the three scores, the ''Six-and-twelve score" showed the best discrimination power: C-index 0.603, Akaike's information criterion (AIC) 1.642, likelihood ratio test (LRT) 16.21.
The ''Six-and-twelve score" is a prognostic tool for patients with HCC treated with DEB-TACE. However, few patients were included in the third group (score >12) and no differences were observed with BCLC, therefore its applicability is limited. .
经动脉化疗栓塞（TACE）在肝细胞癌（HCC）中的疗效取决于合适患者的选择。“六二评分”根据肿瘤数量和大小的总和，将具有不同总生存的三组理想患者区分开来。这可能会影响临床实践和试验设计。本研究的目的是评估该模型在接受载药微球（DEB）-TACE 治疗的西方患者中的可重复性和预后价值。
回顾性、单中心、观察性研究，纳入 2008 年 10 月至 2017 年 10 月连续接受 DEB-TACE 治疗的代偿性患者。排除标准为 Child-Pugh≥8 级和 DEB-TACE 作为肝移植桥接治疗。
共纳入 225 例 HCC 连续患者；BCLC-0/A 期 131 例（单发结节＞5cm，29 例），BCLC-B 期 94 例。中位总生存期（OS）为 27 个月（95%CI 23.8-30.2）。OS 在 BCLC-0/A 期与 BCLC-B 期之间存在差异：30 个月 vs 24 个月（p=0.03），Child-Pugh A5 级与 A6-B7 级：30 个月 vs 27 个月（p=0.003）。“六二评分”组区分 OS：组 1，n=123，32 个月（95%CI 27.5-63.5），组 2，n=101，24 个月（95%CI 19.6-28.4），组 3，n=1，27 个月（p=0.024）。当比较三个评分时，“六二评分”显示出最佳的区分能力：C 指数 0.603，Akaike 信息准则（AIC）1.642，似然比检验（LRT）16.21。
“六二评分”是一种用于 DEB-TACE 治疗 HCC 患者的预后工具。然而，第三个评分组（评分＞12）的患者数量较少，与 BCLC 无差异，因此其适用性有限。
