Retreatment with TACE: The ABCR SCORE, an aid to the decision-making process

• Published in: Journal of hepatology 2015-04, Vol.62 (4), p.855-862
• Main Authors: Adhoute, Xavier, Penaranda, Guillaume, Naude, Sebastien, Raoul, Jean Luc, Perrier, Herve, Bayle, Olivier, Monnet, Olivier, Beaurain, Patrick, Bazin, Christophe, Pol, Bernard, Folgoc, Gaelle Le, Castellani, Paul, Bronowicki, Jean Pierre, Bourlière, Marc
• Format: Article
• Language: English
• Subjects: ABCR score; Aged; ART score; BCLC; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - therapy; Chemoembolization; Chemoembolization, Therapeutic - methods; Chemoembolization, Therapeutic - statistics & numerical data; Decision Support Techniques; Female; France; Gastroenterology and Hepatology; HCC; Humans; Life Sciences; Liver Neoplasms - pathology; Liver Neoplasms - therapy; Male; Middle Aged; Multivariate Analysis; Neoplasm Staging; Outcome Assessment (Health Care); Prognosis; Propensity Score; Radiological response; Retreatment - methods; Retreatment - statistics & numerical data; Retrospective Studies; TACE
• ISSN: 0168-8278; 1600-0641
• DOI: 10.1016/j.jhep.2014.11.014

Background & Aims Transarterial chemoembolization (TACE) is the standard of care for intermediate stage hepatocellular carcinoma (HCC) and it is the most commonly used treatment for HCC worldwide. However, no prognostic indices, designed to select appropriate candidates for repeat conventional TACE, have been incorporated in the guidelines. Methods From January 2007 to April 2012, 139 consecutive HCC patients, mainly with an alcohol- or viral-induced disease, were treated with TACE. Using a regression model on the prognostic variables of our population, we determined a score designed to help for repeat TACE and we validated it in two cohorts. We also compared it to the ART score. Results In the multivariate analysis, four prognostic factors were associated with overall survival: BCLC and AFP (>200 ng/ml) at baseline, increase in Child-Pugh score by ⩾2 from baseline, and absence of radiological response. These factors were included in a score (ABCR, ranging from −3 to +6), which correlates with survival and identifies three groups. The ABCR score was validated in two different cohorts of 178 patients and proofed to perform better than the ART score in distinguishing between patients’ prognosis. Conclusions The ABCR score is a simple and clinically relevant index, summing four prognostic variables endorsed in HCC. An ABCR score ⩾4 prior to the second TACE identifies patients with dismal prognosis who may not benefit from further TACE sessions.