- Email: [email protected]
P976 RETREATMENT WITH TRANSARTERIAL CHEMOEMBOLIZATION (TACE): THE ABCR SCORE, AN AID TO THE DECISION-MAKING PROCESS
POSTERS P975 DYNAMIC CHANGES OF THE INFLAMMATION BASED INDEX (IBI) AS A PREDICTOR OF MORTALITY FOLLOWING TRANS-ARTERIAL CHEMOEMBOLIZATION FOR HEPATOCELLULAR CARCINOMA D.J. Pinato1 , G. Karamanakos1 , A. Goyal2 , D. Adjogatse3 , A.B. Siegel2 , J.L. Weintraub2 , J. Stebbing3 , J.W. Jang4 , R. Sharma1 . 1 Division of Experimental Medicine, Imperial College London, Hammersmith Hospital, London, United Kingdom; 2 Hepatobiliary Oncology, Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, United States; 3 Department of Oncology, Imperial College London, Hammersmith Hospital, London, United Kingdom; 4 Internal Medicine, Catholic University of Korea Incheon St. Mary’s Hospital, Seoul, Korea, Republic of E-mail: [email protected] Background and Aims: Transarterial chemoembolization (TACE) is a standard treatment for unresectable, intermediate stage
hepatocellular carcinoma (HCC). Survival after TACE, however, can be highly variable, with no suitable biomarker predicting for therapeutic outcome. The inflammation based index (IBI) has previously been shown to independently predict overall survival (OS) in all stages of HCC. We explored the prognostic ability of the IBI as a predictor of survival after TACE. Methods: Baseline staging, biochemical and clinicopathologic features together with the IBI were studied in a derivation set of 64 patients undergoing TACE for intermediate stage HCC. Dynamic changes in the IBI before and after TACE were studied as predictors of survival using both a univariate and multivariate Cox regression model and further validated in independent prospectively enrolled patient cohorts (n = 170). Results: Pre-treatment IBI predicted for OS in the derivation set (p = 0.001). Other univariate predictors included radiologic response to TACE (p < 0.001), pre-TACE CLIP score (p < 0.01) (Figure 1A), tumor diameter >5 cm (p = 0.05) and AFP >400 (p < 0.001). Normalization of the IBI post TACE was associated with radiologic response (p < 0.001) (Figure 1B) and improved OS and remained as significant multivariate predictor of OS in both the derivation and validation set (p < 0.001). Conclusions: Normalization of IBI after TACE is shown to be an independent predictor of survival and may integrate the retreatment criteria for repeat TACE in intermediate stage HCC. IBI and its dynamic changes after treatment are validated stratifying biomarker allowing for the identification of patients with a significant survival advantage following initial TACE. P976 RETREATMENT WITH TRANSARTERIAL CHEMOEMBOLIZATION (TACE): THE ABCR SCORE, AN AID TO THE DECISION-MAKING PROCESS X. Adhoute1 , G. Penaranda2 , J.-L. Raoul3 , J.-P. Bronowicki4 , P. Castellani1 , H. Perrier1 , O. Monnet1 , O. Bayle1 , P. Beaurain1 , B. Pol1 , C. Bazin4 , S. Naude4 , V. Oules1 , G. Lefolgoc1 , M. Bourliere1 . 1 Hˆ opital Saint Joseph, 2 AlphaBio Laboratory, 3 Instiut Paoli Calmettes, Marseille, 4 CHU Brabois, Nancy, France E-mail: [email protected]
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Background and Aims: TACE is the standard of care for intermediate stage hepatocellular carcinoma (HCC). However, side effects are frequent and can impair survival. The ART score (based on the increase in AST, Child–Pugh score and the absence of radiologic tumour response) identifies patients who should not continue with TACE after one session. Sieghart W Hepatology 2013. Methods: From 01/2007 to 04/2012, 139 consecutive patients, mostly with viral-induced disease, were treated for HCC by TACE. We used the ART score to determine its prognostic value. Using the same methodology that built the ART score we calculated a new score in our population and we validated it in two cohorts of patients (internal and external). Results: The ART score with a cut-off value at 2.5 differentiated two groups with different survival, but the prognosis was not linearly correlated with the score. In a multivariate analysis we found four prognostic factors associated with OS: baseline BCLC and AFP, increase in Child–Pugh score, absence of radiological response. We calculated a new score (ABCR score) that was correlated with survival. This score was validated in an internal cohort of 53 patients and in an external cohort of 100 patients treated in University Hospital of Nancy. Increase in ABCR score was correlated with the prognosis, unlike ART score. Conclusions: The ART score was not of major value in our HCC population with mainly viral disease. The ABCR score had an excellent value and was well correlated with the prognosis. These results should be confirmed in a prospective study.
Figure 1. S400
Journal of Hepatology 2014 vol. 60 | S361–S522
hepatocellular carcinoma (HCC). Survival after TACE, however, can be highly variable, with no suitable biomarker predicting for therapeutic outcome. The inflammation based index (IBI) has previously been shown to independently predict overall survival (OS) in all stages of HCC. We explored the prognostic ability of the IBI as a predictor of survival after TACE. Methods: Baseline staging, biochemical and clinicopathologic features together with the IBI were studied in a derivation set of 64 patients undergoing TACE for intermediate stage HCC. Dynamic changes in the IBI before and after TACE were studied as predictors of survival using both a univariate and multivariate Cox regression model and further validated in independent prospectively enrolled patient cohorts (n = 170). Results: Pre-treatment IBI predicted for OS in the derivation set (p = 0.001). Other univariate predictors included radiologic response to TACE (p < 0.001), pre-TACE CLIP score (p < 0.01) (Figure 1A), tumor diameter >5 cm (p = 0.05) and AFP >400 (p < 0.001). Normalization of the IBI post TACE was associated with radiologic response (p < 0.001) (Figure 1B) and improved OS and remained as significant multivariate predictor of OS in both the derivation and validation set (p < 0.001). Conclusions: Normalization of IBI after TACE is shown to be an independent predictor of survival and may integrate the retreatment criteria for repeat TACE in intermediate stage HCC. IBI and its dynamic changes after treatment are validated stratifying biomarker allowing for the identification of patients with a significant survival advantage following initial TACE. P976 RETREATMENT WITH TRANSARTERIAL CHEMOEMBOLIZATION (TACE): THE ABCR SCORE, AN AID TO THE DECISION-MAKING PROCESS X. Adhoute1 , G. Penaranda2 , J.-L. Raoul3 , J.-P. Bronowicki4 , P. Castellani1 , H. Perrier1 , O. Monnet1 , O. Bayle1 , P. Beaurain1 , B. Pol1 , C. Bazin4 , S. Naude4 , V. Oules1 , G. Lefolgoc1 , M. Bourliere1 . 1 Hˆ opital Saint Joseph, 2 AlphaBio Laboratory, 3 Instiut Paoli Calmettes, Marseille, 4 CHU Brabois, Nancy, France E-mail: [email protected]
(A)
(B)
Background and Aims: TACE is the standard of care for intermediate stage hepatocellular carcinoma (HCC). However, side effects are frequent and can impair survival. The ART score (based on the increase in AST, Child–Pugh score and the absence of radiologic tumour response) identifies patients who should not continue with TACE after one session. Sieghart W Hepatology 2013. Methods: From 01/2007 to 04/2012, 139 consecutive patients, mostly with viral-induced disease, were treated for HCC by TACE. We used the ART score to determine its prognostic value. Using the same methodology that built the ART score we calculated a new score in our population and we validated it in two cohorts of patients (internal and external). Results: The ART score with a cut-off value at 2.5 differentiated two groups with different survival, but the prognosis was not linearly correlated with the score. In a multivariate analysis we found four prognostic factors associated with OS: baseline BCLC and AFP, increase in Child–Pugh score, absence of radiological response. We calculated a new score (ABCR score) that was correlated with survival. This score was validated in an internal cohort of 53 patients and in an external cohort of 100 patients treated in University Hospital of Nancy. Increase in ABCR score was correlated with the prognosis, unlike ART score. Conclusions: The ART score was not of major value in our HCC population with mainly viral disease. The ABCR score had an excellent value and was well correlated with the prognosis. These results should be confirmed in a prospective study.
Figure 1. S400
Journal of Hepatology 2014 vol. 60 | S361–S522