Frontiers in Oncology (Aug 2021)

Development of a Prognostic Scoring System for Hepatocellular Carcinoma Patients With Main Portal Vein Tumor Thrombus Undergoing Conventional Transarterial Chemoembolization: An Analysis of 173 Patients

  • Jing-huan Li,
  • Jing-huan Li,
  • Jing-huan Li,
  • Xin Yin,
  • Xin Yin,
  • Xin Yin,
  • Wen-shuai Fan,
  • Wen-shuai Fan,
  • Lan Zhang,
  • Lan Zhang,
  • Lan Zhang,
  • Rong-xin Chen,
  • Rong-xin Chen,
  • Rong-xin Chen,
  • Yi Chen,
  • Yi Chen,
  • Yi Chen,
  • Li-xin Li,
  • Li-xin Li,
  • Li-xin Li,
  • Ning-ling Ge,
  • Ning-ling Ge,
  • Ning-ling Ge,
  • Yu-hong Gan,
  • Yu-hong Gan,
  • Yu-hong Gan,
  • Yan-hong Wang,
  • Yan-hong Wang,
  • Yan-hong Wang,
  • Zheng-gang Ren,
  • Zheng-gang Ren,
  • Zheng-gang Ren

DOI
https://doi.org/10.3389/fonc.2021.671171
Journal volume & issue
Vol. 11

Abstract

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BackgroundPatients with hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (mPVTT) have poor prognosis. Promising systemic therapies, such as target therapies, have limited benefits. The purpose of this study is to retrospectively evaluate the benefits of conventional TACE (c-TACE) and to establish a prognostic stratification of HCC patients with mPVTT.MethodsThis is a single center retrospective study conducted over 5 years (duration of performing c-TACE), on consecutive HCC patients with mPVTT receiving c-TACE. Univariable and multivariable analysis were used to explore factors independently associated with overall survival (OS). Based on Cox-regression analysis, prognostic models were developed and internally validated by bootstrap methods. Discrimination and performance were measured by Akaike information criterion, concordance index, and likelihood ratio test.ResultsA total of 173 patients were included. Median OS was 6.0 months (95%CI: 3.92~8.08). The independent variables correlated with survival were largest tumor diameter, tumor number, mPVTT extension, and AFP. In the final model, patients were assigned 2 points if largest tumor diameter ≥8 cm, or tumor number ≥2, 1point if main trunk was complete obstructed, or AFP ≥400 ng/ml. By summing up these points, patients were divided into three risk groups according to the score at the 15rd and 85th percentiles, in which median OS were 18, 7, and 3.5months, respectively (p<0.001). The model shown optimal discrimination, performance, and calibration.Conclusionsc-TACE could provide survival benefits in HCC patients with mPVTT and the proposed prognostic stratification may help to identify good candidates for the treatment, and those for whom c-TACE may be futile.

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