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26-01-2017 | Hepatocellular carcinoma | Article

Transarterial chemo-embolisation of hepatocellular carcinoma: impact of liver function and vascular invasion

Authors:
Imam Waked, Sarah Berhane, Hidenori Toyoda, Stephen L Chan, Nicholas Stern, Daniel Palmer, Toshifumi Tada, Winnie Yeo, Frankie Mo, Dominik Bettinger, Martha M Kirstein, Mercedes Iñarrairaegui, Asmaa Gomaa, Arndt Vogel, Tim Meyer, Bruno Sangro, Paul Lai, Takashi Kumada, Philip Johnson

Abstract

Background

Transarterial chemo-embolisation (TACE) is recommended for patients with BCLC intermediate stage hepatocellular carcinoma (stage B), particularly in patients with good underlying liver function and minimal symptoms. The hepatoma arterial embolisation prognostic (HAP) score combines measures of liver function and tumour-related factors to offer a simple prognostic scoring system. The Albumin-Bilirubin (ALBI) grade permits assessment of the impact of liver function on survival. We aimed to investigate these two models and vascular invasion (VI).

Methods

In an international cohort of 3030 patients undergoing TACE, we examined the impact of liver function as assessed by the ALBI score, the HAP score and VI on survival.

Results

Classification according to ALBI grade resulted in non-overlapping survival curves in the overall data set and all regional cohorts. The HAP score was also validated. Tumour number, aetiology and VI were identified as additional independent prognostic risk factors not currently included in the HAP score. Survival was particularly poor for patients with VI.

Conclusions

The ALBI grade categorised patients receiving TACE into three clear prognostic groups, thereby emphasising the importance of underlying liver function in the outcome of TACE. The HAP score has been validated internationally and the serious adverse impact of VI is clearly shown.

Br J Cancer 2017; 116: 448–454. doi: 10.1038/bjc.2016.423

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