ROLE OF ASSESSSMENT FOR RETREATMENT WITH TRANSARTERIAL CHEMOEMBOLIZATION SCORE IN DECISION OF RETREATMENT WITH TRANS-ARTERIAL CHEMO-EMBOLIZATION SESSIONS IN PATIENTS WITH HEPATOCELLULAR CARCINOMA

Authors

  • Anwar Hussain Abbasi Aga Khan university Hospital, Karachi
  • Shahab Abid Aga khan university hospital, Karachi
  • Tanveer haq Aga khan university hospital, Karachi
  • Safia awan Aga khan university hospital, Karachi

Abstract

Background: The objective behind this study was to determine that Assessment for Re-treatment with Transarterial chemoembolization (ART) score is really applicable in patients with hepatocellular carcinoma. Methods: A cross sectional observational study was conducted on all patients with hepatocellular carcinoma of intermediate stage and undergone ≥2 Transarterial chemoembolization. ART score was assessed before and after each session of Transarterial chemoembolization. Multi-logistic regression analysis was performed to compare the final outcome of patients with ART score of ≥2.5 into groups with two and more than two Trans-arterial chemo-embolization sessions. Results: A total of 100 HCC patients were recruited for final analysis. Our study participants consisted of total 100 HCC patients. Mean Child Pugh score was 6.1±0.95. In our study, most of the study participants (n=63) had ART score of less than 1.5 as compared to ART score >2.5 (n=37). A significant proportion of patients with ART score of <1.5 prior to second Trans-arterial chemo-embolization had better median survival as compared to patients with ART score of >2.5, p-value<0.001. Patients with ART score of more than 2.5 did not show any survival benefit after having 3rd or 4th Trans-arterial chemo-embolization session, p=0.47. Conclusions: Our study findings suggest that those HCC patients who receive multiple sessions of TACE with a low ART score have more favourable outcomes with increased survival rate.Keywords: Hepatocellular carcinoma; Child Pugh Classification; MELD score; ART score

Author Biographies

Anwar Hussain Abbasi, Aga Khan university Hospital, Karachi

Resident Gastro-enterology

Shahab Abid, Aga khan university hospital, Karachi

Section of Gastroenterology, Department of Medicine, Professor

Tanveer haq, Aga khan university hospital, Karachi

Department of Radiology, Professor

Safia awan, Aga khan university hospital, Karachi

Department of Medicine, Senior instructor

References

Butt AS, Hamid S, Wadalawala AA, Ghufran M, Javed AA, Farooq O, et al. Hepatocellular carcinoma in Native South Asian Pakistani population; trends, clinico-pathological characteristics and differences in viral marker negative and viral-hepatocellular carcinoma. BMC Res Notes 2013;6:137.

Butt AS, Abbas Z, Jafri W. Hepatocellular carcinoma in Pakistan: where do we stand? Hepat Mon 2012;12(10 HCC):e6023.

Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011;61(2):69–90.

Forner A, Reig ME, de Lope CR, Bruix J. Current strategy for staging and treatment: the BCLC update and future prospects. Semin Liver Dis 2010;30(1):61–74.

European Association for the Study of the Liver, European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012;56(4):908–43.

Bruix J, Sherman M. Management of hepatocellular carcinoma: an update. Hepatology 2011;53(3):1020–2.

Peck-Radosavljevic M, Sieghart W, Kolblinger C, Reiter M, Schindl M, Ulbrich G, et al. Austrian Joint OGGH-OGIR-OGHO-ASSO position statement on the use of transarterial chemoembolization (TACE) in hepatocellular carcinoma. Wien Klin Wochenschr 2011;124(3-4):104–10.

Hucke F, Sieghart W, Schoniger-Hekele M, Peck-Radosavljevic M, Muller C. Clinical characteristics of patients with hepatocellular carcinoma in Austria– is there a need for a structured screening program? Wien Klin Wochenschr 2011;123(17-18):542–51.

Raoul JL, Sangro B, Forner A, Mazzaferro V, Piscaglia F, Bolondi L, et al. Evolving strategies for the management of intermediate-stage hepatocellular carcinoma: available evidence and expert opinion on the use of transarterial chemoembolization. Cancer Treat Rev 2011;37(3):212–20.

Pinter M, Hucke F, Graziadei I, Vogel W, Maieron A, Königsberg R, et al. Advanced-stage hepatocellular carcinoma: transarterial chemoembolization versus sorafenib. Radiology 2012;263(2):590–9.

Terzi E, Golfieri R, Piscaglia F, Galassi M, Dazzi A, Leoni S, et al. Response rate and clinical outcome of HCC after first and repeated cTACE performed ‘‘on demand’’. J Hepatol 2012;57(6):1258–67.

Tsochatzis E, Garcovich M, Marelli L, Papastergiou V, Fatourou E, Rodriguez-Peralvarez ML, et al. Transarterial embolization as neo-adjuvant therapy pretransplantation in patients with hepatocellular carcinoma. Liver Int 2013;33(6):944–9.

Memon K, Kulik L, Lewandowski RJ, Wang E, Ryu RK, Riaz A, et al. Alpha-fetoprotein response correlates with EASL response and survival in solitary hepatocellular carcinoma treated with transarterial therapies: A subgroup analysis. J Hepatol 2012;56(5):1112–20.

Bolondi L, Burroughs A, Dufour JF, Galle PR, Mazzaferro V, Piscaglia F, et al. Heterogeneity of patients with intermediate (BCLC B) hepatocellular carcinoma: proposal for a subclassification to facilitate treatment decisions. Semin Liver Dis 2012;32(4):348–59.

Sieghart W, Pinter M, Hucke F, Graziadei I, Schoniger-Hekele M, Muller C, et al. A single determination of C-reactive protein at the time of diagnosis predicts long term outcome of patients with hepatocellular carcinoma. Hepatology 2013;57(6):2224–34.

Lencioni R, Llovet JM, Han G, Tak WY, Yang J, Leberre MA, et al. Sorafenib or placebo in combination with transarterial chemoembolization (TACE) with doxorubicin-eluting beads (DEBDOX) for intermediate- stage hepatocellular carcinoma (HCC): Phase II, randomized, double-blind SPACE trial. J Clin Oncol 2012;30 (Suppl 4):LBA154.

Sieghart W, Hucke F, Pinter M, Graziadei I, Vogel W, Mueller C, et al. The ART of decision making: re-treatment with TACE in patients with hepatocellular carcinoma. Hepatology 2013;57(6):2261–73.

Hucke F, Sieghart W, Pinter M, Graziadei I, Vogel W, Muller C, et al. The ART-strategy: sequential assessment of the ART score predicts outcome of patients with hepatocellular carcinoma re-treated with TACE. J Hepatol 2014;60(1):118–26.

Shim JH, Lee HC, Kim SO, Shin YM, Kim KM, Lim YS, et al. Which response criteria best help predict survival of patients with hepatocellular carcinoma following chemoembolization? A validation study of old and new models. Radiology 2012;262(2):708–18.

Gillmore R, Stuart S, Kirkwood A, Hameeduddin A, Woodward N, Burroughs AK, et al. EASL and mRECIST responses are independent prognostic factors for survival in hepatocellular cancer patients treated with transarterial embolization. J Hepatol 2011;55(6):1309–16.

Published

2017-07-11

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