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. 2021 Feb 18;12(2):e00310.
doi: 10.14309/ctg.0000000000000310.

Validation of the "Six-and-Twelve" Prognostic Score in Transarterial Chemoembolization-Treated Hepatocellular Carcinoma Patients

Apichat Kaewdech  1 , Pimsiri Sripongpun  1 , Natcha Cheewasereechon  1 , Sawangpong Jandee  1 , Naichaya Chamroonkul  1 , Teerha Piratvisuth  1   2
Affiliations

Validation of the "Six-and-Twelve" Prognostic Score in Transarterial Chemoembolization-Treated Hepatocellular Carcinoma Patients

Apichat Kaewdech et al. Clin Transl Gastroenterol. .

Abstract

Introduction: The "six-and-twelve" prognostic score was proposed recently to predict survival rate in patients with unresectable hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). However, it has not been validated externally. We validated this score and previous prognostic scores in Thai HCC patients treated with TACE.

Methods: We identified all HCC patients who underwent TACE between January 2007 and December 2018 at our hospital. The inclusion criteria were treatment-naive, unresectable HCC BCLC-A and BCLC-B; if cirrhosis was present, Child-Pugh score ≤7; and baseline performance status 0-1.

Results: Of 716 HCC patients undergoing TACE, 281 (mean age, 61.1 years; 73.0% men, 92.2% with cirrhosis) were eligible. Approximately half of the patients had hepatitis B virus. Median overall survival was 20.3 (95% confidence interval, 16.4-26.3) months. By stratifying with the "six-and-twelve" score (≤6, >6-12, >12), median (95% confidence interval) overall survival was 35.1 (26.4-53.0), 16.0 (11.6-22.6), and 7.6 (5.4-14.9) months, respectively. Area under the receiver operating characteristic curves (AUROCs) predicting death at 1, 2, and 3 years for the "six-and-twelve" score were 0.714, 0.700, and 0.688, respectively. Compared with the other currently available scores, the AUROC predicting death at 1 year for the "six-and-twelve" score was the most predictive and better than other models except the up-to-seven model.

Discussion: Our study confirms the value of the "six-and-twelve" score to predict survival rate of unresectable HCC treated with TACE. However, in our validation cohort, AUROC of the "six-and-twelve" score was slightly lower than that of the original Chinese cohort (0.73).

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Conflict of interest statement

Guarantor of the article: Pimsiri Sripongpun, MD.

Specific author contributions: A.K. contributed to the study concept and design, collecting data, analysis and interpretation of data, and drafting of the manuscript. P.S. contributed to the analysis, interpretation of data, and critical revision of the manuscript. N. Cheewasereechon contributed to data collection and drafting the manuscript. S.J. and N. Chamroonkul contributed to the interpretation of data and critical revision of the article. T.P. contributed to the study concept and design and supervised the study. All authors contributed to critical revisions and approved the final manuscript.

Financial support: This work was supported by the grant from Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.

Potential competing interests: A.K., P.S., N. Cheewasereechon, S.J., and N. Chamroonkul have nothing to declare. T.P. has received research grants from Gilead Sciences, Roche Diagnostic, Janssen, Fibrogen, and VIR and speaker honorarium from Bristol-Myers Squibb, Gilead Sciences, Bayer, Abbott, Esai, Mylan, Ferring, and MSD. All investigators had access to the study data, reviewed, and approved the final manuscript.

Figures

Figure 1.
Figure 1.
Flow chart for patient eligibility. HCC, hepatocellular carcinoma; TACE, transarterial chemoembolization.
Figure 2.
Figure 2.
Kaplan-Meier curve of OS in the entire cohort. CI, confidence interval; OS, overall survival.
Figure 3.
Figure 3.
Kaplan-Meier curve of stratified survival according to the “six-and-twelve” score in the entire cohort. CI, confidence interval; OS, overall survival.
See this image and copyright information in PMC

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