Introduction: The prognosis of patients undergoing transarterial chemoembolization (TACE) is extremely variable, and a confounding factor is that TACE is often repeated several times. We retrospectively evaluated the accuracy of different prognostic scores and staging systems in estimating overall survival (OS) in patients with hepatocellular carcinoma (HCC). Methods: An analysis considering prognostic models as time-varying variables was performed, calculating OS from the time of TACE to the time of the subsequent treatment. Total follow-up time for each patient was therefore split into several observation times accounting for each TACE procedure. Values of the likelihood ratio test (LRT) and Akaike information criterion (AIC) were used to compare different systems. Univariable and multivariable analyses were conducted to identify additional factors predictive of OS. We analyzed 1,610 TACE performed in 1,058 patients recorded in the Italian Liver Cancer database from 2008 through 2016. Results: The median OS of the enrolled patients was 41 months. According to LRT χ² and AIC values based on the time-varying analysis, mHAP-III achieved the best values (41.72 and 4,625.49, respectively, p #x3c; 0.0001), indicating the highest predictive performance compared with all other scores (HAP, mHAP-II, ALBI, and pALBI) and staging systems (MELD, ITALICA, CLIP, MESH, MESIAH, JIS, HKLC, and BCLC). In the multivariable Cox proportional hazards model, mHAP-III maintained an independent effect on OS (hazard ratio 1.31, 95% CI: 1.10–1.55, p #x3c; 0.0001). Time-varying age, alcoholic etiology, radiologic response to TACE, and performing ablation or surgery after TACE were additional significant variables resulting from the multivariable model. Conclusion: An innovative time-varying analysis revealed that mHAP-III was the most accurate model in predicting OS in patients with HCC undergoing TACE. Other clinical pre- and post-TACE variables were also found to be relevant for this prediction.
Liver Cancer

中文翻译：

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时变 mHAP-III 是肝细胞癌患者接受经动脉化疗栓塞术的最准确生存预测指标

引言：接受经动脉化疗栓塞术 (TACE) 的患者预后差异很大，一个混杂因素是 TACE 经常重复数次。我们回顾性评估了不同预后评分和分期系统在估计肝细胞癌 (HCC) 患者总生存期 (OS) 中的准确性。方法：进行了将预后模型视为时变变量的分析，计算了从 TACE 时间到后续治疗时间的 OS。因此，每个患者的总随访时间被分成几个观察时间，考虑到每个 TACE 程序。似然比检验 (LRT) 和 Akaike 信息标准 (AIC) 的值用于比较不同的系统。进行单变量和多变量分析以确定预测 OS 的其他因素。我们分析了从 2008 年到 2016 年在意大利肝癌数据库中记录的 1,058 名患者中进行的 1,610 次 TACE。结果：入组患者的中位 OS 为 41 个月。根据 LRT χ ²基于时变分析的 AIC 和 AIC 值，mHAP-III 达到最佳值（分别为 41.72 和 4,625.49，p #x3c；0.0001），表明与所有其他评分（HAP、mHAP-II、ALBI）相比，预测性能最高和 pALBI）和分期系统（MELD、ITALICA、CLIP、MESH、MESIAH、JIS、HKLC 和 BCLC）。在多变量 Cox 比例风险模型中，mHAP-III 保持对 OS 的独立影响（风险比 1.31，95% CI：1.10–1.55，p #x3c；0.0001）。随时间变化的年龄、酒精性病因、对 TACE 的放射学反应以及在 TACE 后进行消融或手术是多变量模型产生的其他重要变量。结论：一项创新的时变分析表明，mHAP-III 是预测接受 TACE 的 HCC 患者 OS 的最准确模型。其他临床前和后 TACE 变量也被发现与该预测相关。
肝癌