The ART-strategy: Sequential assessment of the ART-score predicts outcome of patients with hepatocellular carcinoma re-treated with TACE

Background:

Recently, we developed the ART-score (Assessment for Retreatment with TACE) to guide the decision for a second transarterial chemoembolization (TACE-2) in patients with hepatocellular carcinoma (HCC). Patients with an ART-score of 0 – 1.5 points gained benefit from a second TACE session, while patients with an ART-score ≥2.5 points did not.

Here, we investigated 1) the prognostic significance of the ART-score prior to the third (TACE-3) and fourth TACE (TACE-4) and 2) the feasibility of an ART-score guided retreatment strategy by sequential assessment of the ART-score in HCC patients treated with multiple TACE sessions.

Methods:

109 patients diagnosed with intermediate stage HCC and treated with ≥3 TACE sessions between 1/1999 and 12/2009 at the Medical Universities of Vienna and Innsbruck were included. The ART score prior to each TACE session was assessed in comparison to the TACE naïve liver. The prognostic performance of the ART-score beforeTACE-3 and 4 was evaluated with and without stratification based on the ART-score prior the respective last intervention.

Results:

The pre-TACE-3 ART-score discriminated two groups with different prognosis and remained a valid predictor of OS independent from Child-Pugh-score (5 – 7 points), CRP-levels and tumor characteristics. Even in patients with an initially beneficial ART-score (0 – 1.5 points) prior to TACE-2, repeated ART score assessment prior to TACE-3 identified a subgroup of patients with dismal prognosis (median OS: 27.8 vs. 10.8 months, p < 0.001). Similar results were observed when the ART score was applied pre-TACE-4.

Conclusion:

The sequential assessment of the ART-score identifies patients with dismal prognosis prior to each TACE session.