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Applicability of clinical scoring systems after transarterial chemoembolisation in the bridging to transplant setting
13 August 2018 (online)
Several scoring systems have been proposed to predict the outcome of transarterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) in palliative treatment indication. However, the application of these scores to the bridging to transplant setting is poorly validated.
Our study evaluated whether other prognostic scores such as ART, CLIP, ALBI, APRI, SNACOR, HAP, Stat Score, Child pugh (CPS) or BCLC score differ for patients with TACE as bridging therapy to liver transplant (LTx) versus patients treated with TACE in palliative intention.
493 TACE procedures were performed from January 2011 to January 2018 in patients presenting with HCC. 92 patients had been treated with TACE as bridging therapy to LTx, 128 were treated in palliative intention. Primary endpoint was overall survival tested between the scores listed above. Data was analyzed out of a prospectively collected SPSS database.
Concerning median overall survival (OS) SNACOR (p = 0,001), CPS (p = 0,047) and BCLC (p = 0,001) showed significant difference in the bridging to LTx group in the univariate analysis. Among multivariate analysis, only SNACOR showed significant difference in this group (p = 0.009). All scores reached statistical significance (p = 0,001) among univariate analysis in the palliative cohort. Among multivariate analysis, APRI score (p = 0,003), State Score (p = 0,001), CPS (p = 0,001) and BCLC (p = 0,006) revealed statistical significance.
Our results are inconsistent with previous studies that patients after TACE should be assessed by ART score in general. Scoring-Systems to predict OS after TACE should be stratified among patient subgroups and used with caution. In our cohort of patients receiving TACE as bridging therapy to LTx, SNACOR reflected best OS.