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Tumor Marker-Based Definition of the Transarterial Chemoembolization-Refractoriness in Intermediate-Stage Hepatocellular Carcinoma: A Multi-Cohort Study.


ABSTRACT: BACKGROUND:For patients with hepatocellular carcinoma (HCC), the definition of refractoriness to transarterial chemoembolization (TACE), which might make them a candidate for systemic therapy, is still controversial. We aimed to derive and validate a tumor marker-based algorithm to define the refractoriness to TACE in patients with intermediate-stage HCC. METHODS:This multi-cohort study was comprised of patients who underwent TACE for treatment-naïve intermediate-stage HCC. We derived a prediction model for overall survival (OS) using the pre- and post-TACE model to predict tumor recurrence after living donor liver transplantation (MoRAL) (i.e., MoRAL score = 11×?protein induced by vitamin K absence-II + 2×?alpha-fetoprotein), which was proven to reflect both tumor burden and biologic aggressiveness of HCC in the explant liver, from a training cohort (n = 193). These results were externally validated in both an independent hospital cohort (from two large-volume centers, n = 140) and a Korean National Cancer Registry sample cohort (n = 149). RESULTS:The changes in MoRAL score (?MoRAL) after initial TACE was an independent predictor of OS (MoRAL-increase vs. MoRAL-non-increase: adjusted hazard ratio (HR) = 2.18, 95% confidence interval (CI) = 1.37-3.46, p = 0.001; median OS = 18.8 vs. 37.8 months). In a subgroup of patients with a high baseline MoRAL score (?89.5, 25th percentile and higher), the prognostic impact of ?MoRAL was more pronounced (MoRAL-increase vs. MoRAL-non-increase: HR = 3.68, 95% CI = 1.54-8.76, p < 0.001; median OS = 9.9 vs. 37.4 months). These results were reproduced in the external validation cohorts. CONCLUSION:The ?MoRAL after the first TACE, a simple and objective index, provides refined prognostication for patients with intermediate-stage HCC. Proceeding to a second TACE may not provide additional survival benefits in cases of a MoRAL-increase after the first TACE in patients with a high baseline MoRAL score (?89.5), who might be candidates for systemic therapy.

SUBMITTER: Yoon JS 

PROVIDER: S-EPMC6896068 | biostudies-literature | 2019 Nov

REPOSITORIES: biostudies-literature

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Tumor Marker-Based Definition of the Transarterial Chemoembolization-Refractoriness in Intermediate-Stage Hepatocellular Carcinoma: A Multi-Cohort Study.

Yoon Jun Sik JS   Sinn Dong Hyun DH   Lee Jeong-Hoon JH   Kim Hwi Young HY   Lee Cheol-Hyung CH   Kim Sun Woong SW   Lee Hyo Young HY   Nam Joon Yeul JY   Chang Young Y   Lee Yun Bin YB   Cho Eun Ju EJ   Yu Su Jong SJ   Kim Hyo-Cheol HC   Chung Jin Wook JW   Kim Yoon Jun YJ   Yoon Jung-Hwan JH  

Cancers 20191104 11


<h4>Background</h4>For patients with hepatocellular carcinoma (HCC), the definition of refractoriness to transarterial chemoembolization (TACE), which might make them a candidate for systemic therapy, is still controversial. We aimed to derive and validate a tumor marker-based algorithm to define the refractoriness to TACE in patients with intermediate-stage HCC.<h4>Methods</h4>This multi-cohort study was comprised of patients who underwent TACE for treatment-naïve intermediate-stage HCC. We der  ...[more]

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