Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China; Department of Interventional Radiology, The First Affiliated Hospital of USTC, Division of Life Sciences & Medicine, University of Science & Technology of China, Hefei 230001, China.
Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China.
Acad Radiol. 2024 Oct;31(10):4034-4044. doi: 10.1016/j.acra.2024.02.039. Epub 2024 Mar 20.
Transarterial chemoembolization (TACE) plus molecular targeted therapies has emerged as the main approach for treating hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). A robust model for outcome prediction and risk stratification of recommended TACE plus molecular targeted therapies candidates is lacking. We aimed to develop an easy-to-use tool specifically for these patients.
A retrospective analysis was conducted on 384 patients with HCC and PVTT who underwent TACE plus molecular targeted therapies at 16 different institutions. We developed and validated a new prognostic score which called ABPS score. Additionally, an external validation was performed on data from 200 patients enrolled in a prospective cohort study.
The ABPS score (ranging from 0 to 3 scores), which involves only Albumin-bilirubin (ALBI, grade 1: 0 score; grade 2: 1 score), PVTT(I-II type: 0 score; III-IV type: 1 score), and systemic-immune inflammation index (SII,<550 × 10: 0 score; ≥550 × 10: 1 score). Patients were categorized into three risk groups based on their ABPS score: ABPS-A, B, and C (scored 0, 1-2, and 3, respectively). The concordance index (C-index) of the ABPS scoring system was calculated to be 0.802, significantly outperforming the HAP score (0.758), 6-12 (0.712), Up to 7 (0.683), and ALBI (0.595) scoring systems (all P < 0.05). These research findings were further validated in the external validation cohorts.
The ABPS score demonstrated a strong association with survival outcomes and radiological response in patients undergoing TACE plus molecular targeted therapy for HCC with PVTT. The ABPS scoring system could serve as a valuable tool to guide treatment selection for these patients.
经动脉化疗栓塞术（TACE）联合分子靶向治疗已成为伴有门静脉癌栓（PVTT）的肝细胞癌（HCC）的主要治疗方法。目前缺乏一种能够准确预测和风险分层推荐行 TACE 联合分子靶向治疗患者预后的可靠模型。本研究旨在为这些患者开发一种易于使用的工具。
回顾性分析了在 16 家不同机构接受 TACE 联合分子靶向治疗的 384 例 HCC 合并 PVTT 患者的临床资料。我们开发并验证了一种新的预后评分系统，称为 ABPS 评分。此外，还对一项前瞻性队列研究中纳入的 200 例患者的数据进行了外部验证。
ABPS 评分（0-3 分）包括白蛋白-胆红素（ALBI，分级 1：0 分；分级 2：1 分）、PVTT（I-II 型：0 分；III-IV 型：1 分）和系统性免疫炎症指数（SII，<550×10：0 分；≥550×10：1 分）。根据 ABPS 评分，患者分为 3 个风险组：ABPS-A、B 和 C（0 分、1-2 分和 3 分）。ABPS 评分系统的一致性指数（C 指数）为 0.802，明显优于 HAP 评分（0.758）、6-12（0.712）、Up to 7（0.683）和 ALBI（0.595）评分系统（均 P<0.05）。这些研究结果在外部验证队列中得到了进一步验证。
ABPS 评分与接受 TACE 联合分子靶向治疗的 HCC 合并 PVTT 患者的生存结局和影像学反应密切相关。ABPS 评分系统可作为指导此类患者治疗选择的有用工具。
