European Radiology ( IF 4.7 ) Pub Date : 2020-03-03 , DOI: 10.1007/s00330-020-06734-8 Felix Peisen 1 , Michael Maurer 1 , Ulrich Grosse 2 , Konstantin Nikolaou 1 , Roland Syha 3 , Dominik Ketelsen 4 , Christoph Artzner 1 , Michael Bitzer 5 , Marius Horger 1 , Gerd Grözinger 1
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:
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。