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

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 J Johnson

doi:10.1038/bjc.2016.423

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

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 J Johnson

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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.

Original language	English
Pages (from-to)	448-454
Number of pages	7
Journal	British Journal of Cancer
Volume	116
Issue number	4
Early online date	26 Jan 2017
DOIs	https://doi.org/10.1038/bjc.2016.423
Publication status	Published - 14 Feb 2017
Externally published	Yes

Keywords

Aged
Bilirubin/blood
Carcinoma, Hepatocellular/blood supply
Chemoembolization, Therapeutic/methods
Cohort Studies
Female
Humans
Liver/blood supply
Liver Neoplasms/blood supply
Male
Middle Aged
Neovascularization, Pathologic/pathology
Prognosis
Reproducibility of Results
Research Design
Serum Albumin/metabolism
Treatment Outcome

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WakedI2017TransarterialFinal published version, 395 KBLicence: Creative Commons: Attribution (CC BY)

Cite this

Waked, I., Berhane, S., Toyoda, H., Chan, S. L., Stern, N., Palmer, D., Tada, T., Yeo, W., Mo, F., Bettinger, D., Kirstein, M. M., Iñarrairaegui, M., Gomaa, A., Vogel, A., Meyer, T., Sangro, B., Lai, P., Kumada, T., & Johnson, P. J. (2017). Transarterial chemo-embolisation of hepatocellular carcinoma: impact of liver function and vascular invasion. British Journal of Cancer, 116(4), 448-454. Advance online publication. https://doi.org/10.1038/bjc.2016.423

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title = "Transarterial chemo-embolisation of hepatocellular carcinoma: impact of liver function and vascular invasion",

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.",

keywords = "Aged, Bilirubin/blood, Carcinoma, Hepatocellular/blood supply, Chemoembolization, Therapeutic/methods, Cohort Studies, Female, Humans, Liver/blood supply, Liver Neoplasms/blood supply, Male, Middle Aged, Neovascularization, Pathologic/pathology, Prognosis, Reproducibility of Results, Research Design, Serum Albumin/metabolism, Treatment Outcome",

author = "Imam Waked and Sarah Berhane and Hidenori Toyoda and Chan, {Stephen L} and Nicholas Stern and Daniel Palmer and Toshifumi Tada and Winnie Yeo and Frankie Mo and Dominik Bettinger and Kirstein, {Martha M} and Mercedes I{\~n}arrairaegui and Asmaa Gomaa and Arndt Vogel and Tim Meyer and Bruno Sangro and Paul Lai and Takashi Kumada and Johnson, {Philip J}",

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doi = "10.1038/bjc.2016.423",

language = "English",

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Waked, I, Berhane, S, Toyoda, H, Chan, SL, Stern, N, Palmer, D, Tada, T, Yeo, W, Mo, F, Bettinger, D, Kirstein, MM, Iñarrairaegui, M, Gomaa, A, Vogel, A, Meyer, T, Sangro, B, Lai, P, Kumada, T & Johnson, PJ 2017, 'Transarterial chemo-embolisation of hepatocellular carcinoma: impact of liver function and vascular invasion', British Journal of Cancer, vol. 116, no. 4, pp. 448-454. https://doi.org/10.1038/bjc.2016.423

TY - JOUR

T1 - Transarterial chemo-embolisation of hepatocellular carcinoma

T2 - impact of liver function and vascular invasion

AU - Waked, Imam

AU - Berhane, Sarah

AU - Toyoda, Hidenori

AU - Chan, Stephen L

AU - Stern, Nicholas

AU - Palmer, Daniel

AU - Tada, Toshifumi

AU - Yeo, Winnie

AU - Mo, Frankie

AU - Bettinger, Dominik

AU - Kirstein, Martha M

AU - Iñarrairaegui, Mercedes

AU - Gomaa, Asmaa

AU - Vogel, Arndt

AU - Meyer, Tim

AU - Sangro, Bruno

AU - Lai, Paul

AU - Kumada, Takashi

AU - Johnson, Philip J

PY - 2017/2/14

Y1 - 2017/2/14

N2 - 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.

AB - 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.

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KW - Bilirubin/blood

KW - Carcinoma, Hepatocellular/blood supply

KW - Chemoembolization, Therapeutic/methods

KW - Cohort Studies

KW - Female

KW - Humans

KW - Liver/blood supply

KW - Liver Neoplasms/blood supply

KW - Male

KW - Middle Aged

KW - Neovascularization, Pathologic/pathology

KW - Prognosis

KW - Reproducibility of Results

KW - Research Design

KW - Serum Albumin/metabolism

KW - Treatment Outcome

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U2 - 10.1038/bjc.2016.423

DO - 10.1038/bjc.2016.423

M3 - Article

C2 - 28125820

SN - 0007-0920

VL - 116

SP - 448

EP - 454

JO - British Journal of Cancer

JF - British Journal of Cancer

IS - 4

ER -

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

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