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Improving prognostication in patients with hepatocellular carcinoma undergoing loco-regional therapy using pre- and post-locoregional therapy scores

  • Interventional Radiology
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Background

Many scoring systems have been proposed for predicting survival in patients with hepatocellular carcinoma (HCC) undergoing locoregional therapy (LRT). We aimed to study the role of the NIACE score, hepatoma arterial embolization prognostic score (HAP), and ABCR score in predicting transplant-free survival (TFS) in these patients.

Methods

In this retrospective multicenter study of a United States Veteran cohort who underwent LRT, NIACE, HAP, and ABCR scores were calculated, and their predictive accuracy for TFS within different modified BCLC (mod-BCLC) stages was analyzed.

Results

180 subjects underwent LRT between January-2012 and March-2019 were followed till January-2022, mean age 65.6 ± 6.3 years, model for end-stage liver disease -sodium (MELD-Na) score (at first LRT) 14.1 ± 6.7. A total of 43.9%, 35%, and 21.1% of patients had mod-BCLC A, B, and C stage disease, respectively. A total of 76.7% underwent transarterial embolization (TAE), 6.1% underwent ablation, and 17.2% underwent transarterial radioembolization (TARE) as the first intervention and were followed for a median of 576.5 patient-years. The NIACE score, HAP score, and ABCR scores differentiated patients within mod-BCLC stages A and B into groups with significant differences in TFS. In the stratified analysis of those undergoing only TAE, all three scores identified subgroups with significantly different TFS.

Conclusion

In patients with HCC undergoing LRT, the mod-BCLC stages have subgroups with variable overall TFS. The NIACE score, HAP score, and ABCR score identified differential prognoses is within mod-BCLC stages and characterized subgroups with different TFS following LRT (TAE). Integration of these scoring systems into treatment decisions would help to improve prognostication within respective mod-BCLC groups, which may help with more customized treatment allocation.

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Acknowledgement

We acknowledge Matthew Deneke MD and Walid Khan MD (at Central Arkansas Veterans Healthcare System Little Rock, USA) for English language revision.

Funding

This study is not funded.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA

    Ragesh B. Thandassery, Charles A. Lavender & Abhilash Perisetti

  2. Department of Diagnostic and Therapeutic Imaging, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA

    Michael Beheshti

Authors
  1. Ragesh B. Thandassery
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  2. Charles A. Lavender
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  3. Abhilash Perisetti
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  4. Michael Beheshti
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Contributions

RT—concept, data analysis, writing manuscript, and final approval; CA—data collection; AP—data analysis; MB—radiology interpretation, interventional radiology procedures, data analysis, writing manuscript, and final approval

Corresponding author

Correspondence to Ragesh B. Thandassery.

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Conflict of interest

There are no conflicts of interest.

Ethical approval

This is a US Government study, approved by the Veterans Affairs Institutional review board. All the research and ethics protocols for conducting a study in a US Veterans cohort population were followed. STROBE criteria for observational study were followed.

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Supplementary Information

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261_2023_4111_MOESM1_ESM.tiff

Supplementary file1 (TIFF 1085 kb)—Fig. 1 Survival plots for patients in modified BCLC stage A. Legend: 4A blue curve for NIACE score >1 and green ≤1; 4B, blue curve for NIACE score >2.5 and green ≤2.5, 4C blue curve for NIACE score >3 and green ≤3, 4D blue curve for HAP score >2 and green ≤2, 4E blue curve ABCR score >2 and green ≤2. P refers to logrank p in Kaplan Meier analysis

261_2023_4111_MOESM2_ESM.tiff

Supplementary file2 (TIFF 941 kb)—Fig. 2 Survival plots for patients in modified BCLC stage C. Legend: 5A blue curve for NIACE score >1 and green ≤1; 5B, blue curve for NIACE score >2.5 and green ≤2.5, 5C blue curve for NIACE score >3 and green ≤3, 5D blue curve for HAP score >2 and green ≤2, 5E blue curve ABCR score >2 and green ≤2. P refers to logrank p in Kaplan Meier analysis

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Thandassery, R.B., Lavender, C.A., Perisetti, A. et al. Improving prognostication in patients with hepatocellular carcinoma undergoing loco-regional therapy using pre- and post-locoregional therapy scores. Abdom Radiol 49, 631–641 (2024). https://doi.org/10.1007/s00261-023-04111-9

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  • DOI: https://doi.org/10.1007/s00261-023-04111-9

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