Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
NKC Institute of Gastroenterology and Hepatology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Clin Transl Gastroenterol. 2022 Jul 1;13(7):e00506. doi: 10.14309/ctg.0000000000000506. Epub 2022 Jun 1.
Patients with unresectable hepatocellular carcinoma treated with conventional transarterial chemoembolization (cTACE) have heterogeneous tumor burden and liver function. Therefore, the selection of patients for repeated cTACE is challenging owing to different outcomes. This study aimed to establish a decision-making scoring system for repeated cTACE to guide further treatment.
All patients with hepatocellular carcinoma who underwent cTACE between 2008 and 2019 were included and randomly assigned into training (n = 324) and validation (n = 162) cohorts. Tumor Size, number of Masses, Albumin-bilirubin score, baseline Alpha-fetoprotein level, and Response to initial cTACE session were selected to generate a "SMAART" score in the training cohort. Patients were stratified according to the SMAART score: low risk, 0-2; medium risk, 3-4; and high risk, 5-8. Prediction error curves based on the integrated Brier score and the Harrell C-index validated the SMAART scores and compared them with the Assessment for Retreatment with Transarterial chemoembolization (ART) score.
The low-risk group had the longest median overall survival of 39.0 months, followed by the medium-risk and high-risk groups of 21.2 months and 10.5 months, respectively, with significant differences (P < 0.001). The validation cohort had similar results. The high-risk group had 63.1% TACE refractory cases. The Harrell C-indexes were 0.562 and 0.665 and the integrated Brier scores were 0.176 and 0.154 for ART and SMAART scores, respectively.
The SMAART score can aid clinicians in selecting appropriate candidates for subsequent cTACE. A SMAART score of ≥5 after the first cTACE session identified patients with poor prognosis who may not benefit from additional cTACE sessions.
接受常规经动脉化疗栓塞术（cTACE）治疗的不可切除肝细胞癌患者肿瘤负担和肝功能存在差异。因此，由于不同的结果，再次进行 cTACE 的患者选择具有挑战性。本研究旨在建立一个用于重复 cTACE 的决策评分系统，以指导进一步治疗。
所有 2008 年至 2019 年接受 cTACE 的肝细胞癌患者均纳入并随机分配到训练（n = 324）和验证（n = 162）队列。在训练队列中，选择肿瘤大小、肿块数量、白蛋白-胆红素评分、基线甲胎蛋白水平和对初始 cTACE 治疗的反应来生成“SMAART”评分。根据 SMAART 评分对患者进行分层：低危，0-2；中危，3-4；高危，5-8。基于综合 Brier 评分和 Harrell C 指数的预测误差曲线验证了 SMAART 评分，并将其与评估经动脉化疗栓塞术（ART）再治疗评分进行比较。
低危组的中位总生存期最长，为 39.0 个月，其次是中危组和高危组，分别为 21.2 个月和 10.5 个月，差异有统计学意义（P < 0.001）。验证队列也有类似的结果。高危组有 63.1%的患者 TACE 耐药。ART 和 SMAART 评分的 Harrell C 指数分别为 0.562 和 0.665，综合 Brier 评分分别为 0.176 和 0.154。
SMAART 评分可以帮助临床医生选择合适的候选者进行后续 cTACE。首次 cTACE 后 SMAART 评分≥5 可识别出预后不佳的患者，他们可能无法从额外的 cTACE 治疗中获益。
