Time-Varying mHAP-III Is the Most Accurate Predictor of Survival in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization
Claudia Campani,
Alessandro Vitale,
Gabriele Dragoni,
Umberto Arena,
Giacomo Laffi,
Umberto Cillo,
Edoardo G. Giannini,
Francesco Tovoli,
Gian Ludovico Rapaccini,
Maria Di Marco,
Eugenio Caturelli,
Marco Zoli,
Rodolfo Sacco,
Giuseppe Cabibbo,
Andrea Mega,
Maria Guarino,
Antonio Gasbarrini,
Gianluca Svegliati-Baroni,
Francesco Giuseppe Foschi,
Elisabetta Biasini,
Alberto Masotto,
Gerardo Nardone,
Giovanni Raimondo,
Francesco Azzaroli,
Gianpaolo Vidili,
Maurizia Rossana Brunetto,
Fabio Farinati,
Franco Trevisani,
Fabio Marra
Affiliations
Claudia Campani
Internal Medicine and Hepatology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Alessandro Vitale
Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
Gabriele Dragoni
Internal Medicine and Hepatology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Umberto Arena
Internal Medicine and Hepatology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Giacomo Laffi
Internal Medicine and Hepatology Unit, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
Umberto Cillo
Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
Edoardo G. Giannini
Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Policlinico San Martino, Genoa, Italy
Francesco Tovoli
Internal Medicine-Piscaglia Unit, Azienda Ospedaliero-Universitaria S. Orsola-Malpighi, University of Bologna, Bologna, Italy
Gian Ludovico Rapaccini
Gastroenterology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
Maria Di Marco
Medicine Unit, Bolognini Hospital, Seriate, Italy
Eugenio Caturelli
Gastroenterology Unit, Belcolle Hospital, Viterbo, Italy
Marco Zoli
Internal Medicine-Zoli Unit, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
Rodolfo Sacco
Gastroenterology and Digestive Endoscopy Unit, Foggia University Hospital, Foggia, Italy
Giuseppe Cabibbo
Gastroenterology & Hepatology Unit, Department of Health Promotion, Mother & Child Care, Internal Medicine & Medical Specialties, PROMISE, University of Palermo, Palermo, Italy
Andrea Mega
Gastroenterology Unit, Bolzano Regional Hospital, Bolzano, Italy
Maria Guarino
Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
Antonio Gasbarrini
Internal Medicine and Gastroenterology Unit, Policlinico Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
Gianluca Svegliati-Baroni
Liver Injury and Transplant Unit, and Obesity Center, Polytechnic University of Marche, Ancona, Italy
Francesco Giuseppe Foschi
Department of Internal Medicine, Ospedale per gli Infermi di Faenza, Faenza, Italy
Elisabetta Biasini
Infectious Diseases and Hepatology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
Alberto Masotto
Gastroenterology Unit, Ospedale Sacro Cuore Don Calabria, Negrar, Italy
Gerardo Nardone
Hepato-Gastroenterology Unit, Department of Clinical Medicine and Surgery, University of Naples “Federico II”, Naples, Italy
Giovanni Raimondo
Clinical and Molecular Hepatology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
Francesco Azzaroli
Gastroenterology Unit, Department of Surgical and Medical Sciences, Alma Mater Studiorum – Università of Bologna, Bologna, Italy
Gianpaolo Vidili
Department of Medical, Surgical and Experimental Sciences, Sassari, Italy
Maurizia Rossana Brunetto
Hepatology and Liver Physiopathology Laboratory and Internal Medicine, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Fabio Farinati
Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
Franco Trevisani
Department of Medical and Surgical Sciences, Semeiotics Unit, Alma Mater Studiorum-University of Bologna, Bologna, Italy
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 < 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 < 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.
