Retreatment with TACE: the ABCR SCORE, an aid to the decision-making process.

BACKGROUND & AIMS: Transarterial chemoembolization (TACE) is the standard of care for intermediate stage hepatocellular carcinoma (HCC) and it is the most commonly used treatment for HCC worldwide. However, no prognostic indices, designed to select appropriate candidates for repeat conventional TACE, have been incorporated in the guidelines. METHODS: From January 2007 to April 2012, 139 consecutive HCC patients, mainly with an alcohol- or viral-induced disease, were treated with TACE. Using a regression model on the prognostic variables of our population, we determined a score designed to help for repeat TACE and we validated it in two cohorts. We also compared it to the ART score. RESULTS: In the multivariate analysis, four prognostic factors were associated with overall survival: BCLC and AFP (>200 ng/ml) at baseline, increase in Child-Pugh score by ⩾2 from baseline, and absence of radiological response. These factors were included in a score (ABCR, ranging from -3 to +6), which correlates with survival and identifies three groups. The ABCR score was validated in two different cohorts of 178 patients and proofed to perform better than the ART score in distinguishing between patients' prognosis. CONCLUSIONS: The ABCR score is a simple and clinically relevant index, summing four prognostic variables endorsed in HCC. An ABCR score ⩾4 prior to the second TACE identifies patients with dismal prognosis who may not benefit from further TACE sessions.

Value of ABCR scoring system in assessing the prognosis of hepatocellular carcinoma after transcatheter arterial chemoembolization / 临床肝胆病杂志

ObjectiveTo investigate the value of ABCR clinical scoring system in guiding repeated transcatheter arterial chemoembolization (TACE) therapy for patients with hepatocellular carcinoma (HCC) and the treatment strategies for patients with an ABCR score of 1-3. MethodsThe patients with HCC who underwent TACE in The First Affiliated Hospital of Soochow University from January 2008 to December 2017 were enrolled. In order to investigate the effect of repeated TACE in patients with different ABCR scores, 229 patients who underwent repeated TACE consecutively (at least twice, without systemic therapy) were enrolled as group A, which was further divided into group A1 with 92 patients (an ABCR score of ≤0), group A2 with 78 patients (an ABCR score of 1-3), and group A3 with 59 patients (an ABCR score of ≥4). In order to investigate the survival time of patients with an ABCR score of 1-3 who received different regimens after first TACE therapy, 118 patients with an ABCR score of 1-3 who received TACE for the first time were enrolled as group B, which was further divided into group B1 with 78 patients (treated with TACE after first TACE therapy), group B2 with 21 patients (treated with TACE combined with sorafenib), and group B3 with 19 patients (treated with sorafenib alone). The survival of the above groups of patients were analyzed. The Fisher’s exact test was used for comparison of categorical data between groups, the Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for comparison of survival time between groups. ResultsThe median survival time was 320 months (95% confidence interval ［CI］: 27.7-36.3) in group A1, 10.3 months (95%CI: 8.4-12.2) in group A2, and 4.6 months (95%CI: 3.7-5.5) in group A3. Group A1 had a better survival time than group A2 (χ2=106.99, P＜0.01), and group A2 had a better survival time than group A3 (χ2=49.66, P＜0.01). The median survival time was 10.3 months (95%CI: 8.4-12.2) in group B1, 14.8 months (95%CI: 7.8-21.8) in group B2, and 6.0 months (95%CI: 4.6-7.4) in group B3, and group B2 had a better survival time than group B1 (χ2=6.80, P＜0.01) and group B3 (χ2=29.89, P＜0.01). ConclusionThe ABCR score has a certain guiding significance for the treatment of HCC patients. Repeated TACE may be considered for patients with an ABCR score of ≤0, while patients with an ABCR score of ≥4 may not benefit from further TACE therapy, and TACE combined with sorafenib might bring maximum benefits to patients with an ABCR score of 1-3.