RESUMEN
Introduction: The appropriate selection of hepatocellular carcinoma (HCC) patients who are eligible for transarterial chemoembolization (TACE) remains a challenge. The ART score has recently been proposed as a method of identifying patients who are eligible or not for a second TACE procedure. Objective: To assess the validity of the Assessment for Retreatment with TACE (ART) score in a cohort of patients treated with drug-eluting bead TACE (DEB-TACE). Secondary objective: to identify clinical determinants associated with overall survival (OS). Method: A retrospective, multicentre study conducted in Spain in patients with HCC having undergone two or more DEB-TACE procedures between January 2009 and December 2014. The clinical characteristics and OS from the day before the second DEB-TACE of patients with a high ART score (ART≥2.5) and a low ART score (ART 0-1) were compared. Risk factors for mortality were identified using Cox's proportional hazards model. Results: Of the 102 patients included, 51 scored 0-1.5 and 51 scored ≥2.5. Hepatitis C was more frequent in patients scoring ≥2.5. Median OS from the day before the second DEB-TACE was 21 months (95% CI, 15-28) in the group scoring 0-1.5, and 17 months (95% CI, 10-25) in the group scoring ≥2.5 (P=0.3562). Platelet count and tumour size, but not the ART score, were independent baseline predictors of OS. Conclusions: The ART score is not suitable for guiding DEB-TACE retreatment according to Spanish clinical practice standards (AU)
Introducción: La selección de los candidatos ideales con carcinoma hepatocelular (CHC) que más se benefician de realizar quimioembolización transarterial (TACE) sigue siendo un reto. Recientemente se ha propuesto el índice ART para seleccionar a aquellos pacientes tributarios o no de realizar un segundo procedimiento de TACE. Objetivo: Evaluar la validez del índice ART en una cohorte tratada con TACE con partículas cargadas (DEB-TACE). Objetivo secundario: identificar los factores clínicos asociados con la supervivencia global. Método: Estudio retrospectivo multicéntrico español en pacientes con CHC tratados con≥2 DEB-TACE entre enero del 2009 y diciembre del 2014. Se compararon las características clínicas y la supervivencia global desde el día previo a la segunda DEB-TACE entre los pacientes con ART alto (ART≥2,5) y bajo (ART 0-1). Los factores de riesgo de mortalidad se identificaron usando el modelo de riesgos proporcionales de Cox. Resultados: De los 102 pacientes incluidos, 51 obtuvieron puntuación de 0-1,5 y 51 ≥ 2,5. La hepatitis C fue más frecuente en pacientes con puntuación ≥ 2,5. La supervivencia global mediana desde el día previo a DEB-TACE-2 fue de 21 meses (IC del 95%, 15-28) y de 17 meses (IC del 95%, 10-25) en los pacientes con ART 0-1,5 y ≥ 2,5, respectivamente (p=0,3562). Los factores basales predictores independientes de supervivencia fueron el recuento de plaquetas y el tamaño del tumor, pero no el índice ART. Conclusiones: El índice ART no es adecuado para guiar el retratamiento con DEB-TACE según los estándares de práctica clínica español (AU)
Asunto(s)
Humanos , Carcinoma Hepatocelular/terapia , Neoplasias Hepáticas/terapia , Quimioembolización Terapéutica , Ajuste de Riesgo/métodos , Selección de Paciente , Reproducibilidad de los Resultados , Factores de Riesgo , Análisis de Supervivencia , Estudios Retrospectivos , Estadificación de NeoplasiasRESUMEN
INTRODUCTION: The appropriate selection of hepatocellular carcinoma (HCC) patients who are eligible for transarterial chemoembolization (TACE) remains a challenge. The ART score has recently been proposed as a method of identifying patients who are eligible or not for a second TACE procedure. OBJECTIVE: To assess the validity of the Assessment for Retreatment with TACE (ART) score in a cohort of patients treated with drug-eluting bead TACE (DEB-TACE). SECONDARY OBJECTIVE: to identify clinical determinants associated with overall survival (OS). METHOD: A retrospective, multicentre study conducted in Spain in patients with HCC having undergone two or more DEB-TACE procedures between January 2009 and December 2014. The clinical characteristics and OS from the day before the second DEB-TACE of patients with a high ART score (ART≥2.5) and a low ART score (ART 0-1) were compared. Risk factors for mortality were identified using Cox's proportional hazards model. RESULTS: Of the 102 patients included, 51 scored 0-1.5 and 51 scored ≥2.5. Hepatitis C was more frequent in patients scoring ≥2.5. Median OS from the day before the second DEB-TACE was 21 months (95% CI, 15-28) in the group scoring 0-1.5, and 17 months (95% CI, 10-25) in the group scoring ≥2.5 (P=0.3562). Platelet count and tumour size, but not the ART score, were independent baseline predictors of OS. CONCLUSIONS: The ART score is not suitable for guiding DEB-TACE retreatment according to Spanish clinical practice standards.
