Objectives

To evaluate the predictive performance of the modified hepatoma arterial embolisation prognostic II (mHAP-II) score in a real-life western hepatocellular carcinoma (HCC) cohort treated with drug-eluting bead-TACE and compare the mHAP-II with other scores in this cohort.

Methods

One hundred seventy-nine HCC patients (mean age 77 (± 9) years, 87% male) with one or more drug-eluting bead (DEB)-TACE sessions using 100–300 μm microspheres were retrospectively analysed. Performance analysis of the mHAP-II score was based on Mann-Whitney U tests, the Kaplan-Meier method, log-rank tests, receiver operating characteristics, Akaike’s information criterion and Cox regression models.

Results

In this population, HCC risk factors were mainly alcohol abuse (31%) and hepatitis C (28%). The median survival of the entire cohort was 29.4 months. mHAP-II classification of the cohort was mHAP-II B (30%), C (41%) and D (23%) respectively. Survival of all subgroups differed significantly from each other (each p < 0.05). Area under the curve for receiver operating characteristic was 0.60 and Akaike’s information criterion was 21.8 (p = 0.03), indicating a superior performance of mHAP-II score compared with HAP score and BCLC. Tumour number ≥ two (HR 1.54), alpha-fetoprotein > 400 μg/l (HR 1.14), serum albumin < 3.6 g/dl (HR 1.63) and total bilirubin > 0.9 mg/dl (HR 1.58) contributed significantly in Cox proportional hazards regression (each p < 0.05).

Conclusion

The mHAP-II score can predict survival outcomes of western HCC patients undergoing DEB-TACE and further subdivide this heterogeneous group; however, certain limitations concerning the predictive power of mHAP-II score must be taken into account.

Key Points

• This retrospective study evaluated the predictive performance of the modified hepatoma arterial embolisation prognostic II (mHAP-II) score in a real-life western HCC cohort treated with drug-eluting bead-TACE.

• Survival of all mHAP-II subgroups differed significantly, area under the curve for mHAP-II was 0.60 and Akaike’s information criterion was 21.8.

• The mHAP-II score can predict survival outcomes of western HCC patients undergoing DEB-TACE and further subdivide this heterogeneous group. However, because the study is underpowered, true survival prediction may be more difficult to infer.

中文翻译：

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使用药物洗脱珠子（DEB-TACE）经动脉化学栓塞后，在现实生活中的西方肝细胞癌西方人群中，mHAP-II评分的预测性能。

目标

为了评估改良的肝癌动脉栓塞预后II（mHAP-II）评分在用药物洗脱微珠TACE治疗的现实生活中的西方肝细胞癌（HCC）队列中的预测性能，并将mHAP-II与其他评分进行比较队列。

方法

回顾性分析了使用100-300μm微球体的179例HCC患者（平均年龄77（±9）岁，男性87％），进行了一个或多个药物洗脱珠（DEB）-TACE治疗。mHAP-II分数的性能分析基于Mann-Whitney U检验，Kaplan-Meier方法，对数秩检验，接收器工作特性，Akaike的信息标准和Cox回归模型。

结果

在这一人群中，肝癌的危险因素主要是酗酒（31％）和丙型肝炎（28％）。整个队列的中位生存期为29.4个月。队列的mHAP-II分类分别为mHAP-II B（30％），C（41％）和D（23％）。所有亚组的生存率均存在显着差异（每个p  <0.05）。接收器工作特性曲线下的面积为0.60，Akaike的信息标准为21.8（p =  0.03），表明mHAP-II评分优于HAP评分和BCLC。肿瘤数量≥2（HR 1.54），甲胎蛋白> 400μg/ l（HR 1.14），血清白蛋白<3.6 g / dl（HR 1.63）和总胆红素> 0.9 mg / dl（HR 1.58）对Cox成比例有显着影响危害回归（每个p  <0.05）。

结论

mHAP-II评分可以预测接受DEB-TACE的西方HCC患者的生存结局，并进一步细分该异类人群。但是，必须考虑到有关mHAP-II评分预测能力的某些限制。

关键点

•这项回顾性研究评估了经药物洗脱珠粒-TACE治疗的真实西方HCC队列中改良肝癌动脉栓塞预后II（mHAP-II）评分的预测性能。

•所有mHAP-II亚组的生存率均存在显着差异，mHAP-II曲线下面积为0.60，Akaike的信息标准为21.8。

•mHAP-II评分可以预测接受DEB-TACE的西方HCC患者的生存结局，并进一步细分该异类人群。但是，由于这项研究的能力不足，因此可能难以推断出真实的生存预测。