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. 2021 Jun 26;9(18):4559-4572.
doi: 10.12998/wjcc.v9.i18.4559.

Expected outcomes and patients' selection before chemoembolization-"Six-and-Twelve or Pre-TACE-Predict" scores may help clinicians: Real-life French cohorts results

Xavier Adhoute  1 , Edouard Larrey  2 , Rodolphe Anty  2 , Patrick Chevallier  3 , Guillaume Penaranda  4 , Albert Tran  2 , Jean-Pierre Bronowicki  5 , Jean-Luc Raoul  6 , Paul Castellani  7 , Hervé Perrier  7 , Olivier Bayle  8 , Olivier Monnet  8 , Bernard Pol  9 , Marc Bourliere  7
Affiliations

Expected outcomes and patients' selection before chemoembolization-"Six-and-Twelve or Pre-TACE-Predict" scores may help clinicians: Real-life French cohorts results

Xavier Adhoute et al. World J Clin Cases. .

Abstract

Background: Careful selection of hepatocellular carcinoma (HCC) patients prior to chemoembolization treatment is a daily reality, and is even more necessary with new available therapeutic options in HCC.

Aim: To propose two new models to better stratify patients and maximize clinical benefit: "6 and 12" and "pre/post-TACE-predict" (TACE, transarterial chemoembolization).

Methods: We evaluated and compared their performance in predicting overall survival with other systems {Barcelona Clinic Liver Cancer (BCLC), Albumin-Bilirubin (ALBI) and NIACE [Number of tumor(s), Infiltrative HCC, alpha-fetoprotein, Child-Pugh (CP), and performance status]} in two HCC French cohorts of different stages enrolled between 2010 and 2018.

Results: The cohorts included 324 patients classified as BCLC stages A/B (cohort 1) and 137 patients classified as BCLC stages B/C (cohort 2). The majority of the patients had cirrhosis with preserved liver function. "Pre-TACE-predict" and "6 and 12" models identified three distinct categories of patients exhibiting different prognosis in cohort 1. However, their prognostic value was no better than the BCLC system or NIACE score. Liver function based on CP and ALBI grades significantly impacted patient survival. Conversely, the "post-TACE-predict" model had a higher predictive value than other models. The stratification ability as well as predictive performance of these new models in an intermediate/advanced stage population was less efficient (cohort 2).

Conclusion: The newly proposed "Pre-TACE-predict" and "6 and 12" models offer an interesting stratification into three categories in a recommended TACE population, as they identify poor candidates, those with partial control and durable response. The models' contribution was reduced in a population with advanced stage HCCs.

Keywords: Barcelona Clinic Liver Cancer; Hepatocellular carcinoma; Pre-TACE-predict; Prognosis; Six-and-twelve; Transarterial chemoembolization.

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Conflict of interest statement

Conflict-of-interest statement: The authors have no potential conflict of interest relative to this article. Adhoute X: Board member (Bayer, Ipsen, Eisai); Grant from Ipsen, Eisai. Anty R: Board member (Gilead, Bayer, Eisai, Intercept, Abbvie, MSD, Ipsen). Chevallier P: Board member (Bayer). Tran A: Board member (Gilead, Bayer, Eisai, Intercept, Abbvie, MSD, Ipsen). Bronowicki JP: Board member (Merck-Schering Plough, Janssen, Roche, BMS, Boehringer-Ingelheim, Gilead, Novartis, GSK, Bayer). Raoul JL: Board member (Bayer, BMS, Daichi). Castellani P: Board member (Gilead). Bourlière M: Board member (Merck-Schering Plough, Gilead, Janssen, Vertex, Boehringer-Ingelheim, BMS, Roche, Abbvie, GSK). Pénaranda G, Perrier H, Monnet O, Bayle O and Pol B have no conflict of interest.

Figures

Figure 1
Figure 1
Patients’ allocation and survival according to scoring systems in cohort 1 (recommended transarterial chemoembolization patients). NIACE: Number of tumor(s), Infiltrative hepatocellular carcinoma, Alpha-fetoprotein, Child-Pugh class, Eastern Cooperative Oncology Group Performance Status; 6&12: “Six-and-Twelve”; ALBI: Albumin-Bilirubin; NS: Not significant; G: Grade; C: Category; TACE: Transarterial chemoembolization.
Figure 2
Figure 2
Kaplan-Meier analysis of overall survival according to “pre-transarterial chemoembolization-predict” model in the multicenter French hepatocellular carcinoma cohort (n = 324). C: Category.
Figure 3
Figure 3
Patients’ allocation and survival according to scoring systems in cohort 2 (intermediate/advanced stage hepatocellular carcinomas). NIACE: Number of tumor(s), Infiltrative hepatocellular carcinoma, Alpha-fetoprotein, Child-Pugh class, Eastern Cooperative Oncology Group Performance Status; 6&12: “Six-and-Twelve”; ALBI: Albumin-Bilirubin; NS: Not significant; G: Grade; C: Category; TACE: Transarterial chemoembolization.
Figure 4
Figure 4
Summary of the study (patients' stratification according to the newly proposed scoring systems: “6 and 12” and “Pre-TACE-Predict”). TACE: Transarterial chemoembolization; PS: Performance status; PVT: Portal vein thrombosis; EHS: Extra-hepatic spread; “6&12”: “Six-and-Twelve”; cTACE: Conventional transarterial chemoembolization; OS: Overall survival; ICIs: Immune checkpoint inhibitors.
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