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A differential risk assessment and decision model for Transarterial chemoembolization in hepatocellular carcinoma based on hepatic function.
Nam, Joon Yeul; Choe, A Reum; Sinn, Dong Hyun; Lee, Jeong-Hoon; Kim, Hwi Young; Yu, Su Jong; Kim, Yoon Jun; Yoon, Jung-Hwan; Lee, Jeong Min; Chung, Jin Wook; Choi, Sun Young; Lee, Jeong Kyong; Baek, Seung Yon; Lee, Hye Ah; Kim, Tae Hun; Yoo, Kwon.
Afiliação
  • Nam JY; Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea.
  • Choe AR; Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
  • Sinn DH; Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea.
  • Lee JH; Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
  • Kim HY; Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. pindra@empal.com.
  • Yu SJ; Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea. hwiyoung@ewha.ac.kr.
  • Kim YJ; Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
  • Yoon JH; Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
  • Lee JM; Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
  • Chung JW; Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
  • Choi SY; Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.
  • Lee JK; Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
  • Baek SY; Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
  • Lee HA; Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea.
  • Kim TH; Clinical Trial Center, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea.
  • Yoo K; Department of Internal Medicine, College of Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, 07985, Republic of Korea.
BMC Cancer ; 20(1): 504, 2020 Jun 01.
Article em En | MEDLINE | ID: mdl-32487089
BACKGROUND: The decision of transarterial chemoembolization (TACE) initiation and/or repetition remains challenging in patients with unresectable hepatocellular carcinoma (HCC). The aim was to develop a prognostic scoring system to guide TACE initiation/repetition. METHODS: A total of 597 consecutive patients who underwent TACE as their initial treatment for unresectable HCC were included. We derived a prediction model using independent risk factors for overall survival (OS), which was externally validated in an independent cohort (n = 739). RESULTS: Independent risk factors of OS included Albumin-bilirubin (ALBI) grade, maximal tumor size, alpha-fetoprotein, and tumor response to initial TACE, which were used to develop a scoring system ("ASAR"). C-index values for OS were 0.733 (95% confidence interval [CI] = 0.570-0.871) in the derivation, 0.700 (95% CI = 0.445-0.905) in the internal validation, and 0.680 (95% CI = 0.652-0.707) in the external validation, respectively. Patients with ASAR< 4 showed significantly longer OS than patients with ASAR≥4 in all three datasets (all P < 0.001). Among Child-Pugh class B patients, a modified model without TACE response, i.e., "ASA(R)", discriminated OS with a c-index of 0.788 (95% CI, 0.703-0.876) in the derivation, and 0.745 (95% CI, 0.646-0.862) in the internal validation, and 0.670 (95% CI, 0.605-0.725) in the external validation, respectively. Child-Pugh B patients with ASA(R) < 4 showed significantly longer OS than patients with ASA(R) ≥ 4 in all three datasets (all P < 0.001). CONCLUSIONS: ASAR provides refined prognostication for repetition of TACE in patients with unresectable HCC. For Child-Pugh class B patients, a modified model with baseline factors might guide TACE initiation.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Quimioembolização Terapêutica / Carcinoma Hepatocelular / Cirrose Hepática / Neoplasias Hepáticas / Antineoplásicos Idioma: En Ano de publicação: 2020 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Quimioembolização Terapêutica / Carcinoma Hepatocelular / Cirrose Hepática / Neoplasias Hepáticas / Antineoplásicos Idioma: En Ano de publicação: 2020 Tipo de documento: Article