Wednesday, August 7, 2013

Scoring tool predicts outcome of liver cancer treated with arterial embolization

Scoring tool predicts outcome of liver cancer treated with arterial embolization

Last Updated: 2013-08-06 13:49:06 -0400 (Reuters Health)

NEW YORK (Reuters Health) - A score based on four factors -- low albumin, high bilirubin and alfa-fetoprotein, and large tumor size -- is closely associated with mortality risk in patients with hepatocellular cancer (HCC) undergoing transarterial chemoembolization (TACE) or bland arterial embolization (TAE).

The scoring system "may help guide treatment selection, allow stratification in clinical trials and facilitate meaningful comparisons across reported series," according to the authors of the report in the Annals of Oncology online July 14.

As they explain, the prognosis is variable for patients with unresectable HCC for whom arterial embolization may be recommended, and a simple, reliable prognostic index would be valuable.

To develop such a scoring system, Dr. Tim Meyer at University College London and colleagues elsewhere in the UK first identified predictors of survival using data from a set of 114 patients treated with TACE/TAE. They then validated the findings in an independent dataset of 167 patients.

Cox regression analysis showed adjusted hazard ratios for mortality of 3.03 for albumin <36 g/dL; 2.21 for bilirubin >17 mcmol/L; 2.50 for alfa-fetoprotein >400 ng/mL; and 2.51 for a largest lesion >70 mm, according to the report.

The researchers assigned 1 point for each of those risk factors, and the sum of the points formed the individual prognostic score (termed the HAP score).

Median survival for a HAP score of 0, 1, 2 or >2 was 27.6, 18.5, 9.0, and 3.6 months, respectively.

The HAP score was equally predictive in the validation sample. In both cohorts, a HAP score of 2 or greater "defined poor prognosis groups which are unlikely to have benefited from TACE and might now be better served with systemic therapy or supportive care," Dr. Meyer and colleagues suggest.

Furthermore, the HAP score proved more accurate than five other scoring systems in identifying high- and low-risk groups, the team found.

Overall, they conclude, "We have defined a simple and clinically relevant prognostic index requiring the measurement of two tumour variables and two liver variables, specifically for patients undergoing TACE."

Still, they add, "It is appropriate to prospectively validate it on a larger cohort to confirm our findings."


Ann Oncol 2013.

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