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

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)...

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Main Authors: Jing-huan Li, Xin Yin, Wen-shuai Fan, Lan Zhang, Rong-xin Chen, Yi Chen, Li-xin Li, Ning-ling Ge, Yu-hong Gan, Yan-hong Wang, Zheng-gang Ren
Format: Article
Language:English
Published: Frontiers Media S.A. 2021-08-01
Series:Frontiers in Oncology
Subjects:
Online Access:https://www.frontiersin.org/articles/10.3389/fonc.2021.671171/full
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author 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
spellingShingle 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
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
Frontiers in Oncology
hepatocellular carcinoma (HCC)
portal vein tumor thrombus (PVTT)
transarterial chemoembolization (TACE)
overall survival (OS)
prognosis
model
author_facet 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
author_sort Jing-huan Li
title 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
title_short 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
title_full 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
title_fullStr 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
title_full_unstemmed 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
title_sort 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
publisher Frontiers Media S.A.
series Frontiers in Oncology
issn 2234-943X
publishDate 2021-08-01
description 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.
topic hepatocellular carcinoma (HCC)
portal vein tumor thrombus (PVTT)
transarterial chemoembolization (TACE)
overall survival (OS)
prognosis
model
url https://www.frontiersin.org/articles/10.3389/fonc.2021.671171/full
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spelling doaj-385a252f4b7d4f4db66afcf8993ab89e2021-08-27T23:44:08ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-08-011110.3389/fonc.2021.671171671171Development of a Prognostic Scoring System for Hepatocellular Carcinoma Patients With Main Portal Vein Tumor Thrombus Undergoing Conventional Transarterial Chemoembolization: An Analysis of 173 PatientsJing-huan Li0Jing-huan Li1Jing-huan Li2Xin Yin3Xin Yin4Xin Yin5Wen-shuai Fan6Wen-shuai Fan7Lan Zhang8Lan Zhang9Lan Zhang10Rong-xin Chen11Rong-xin Chen12Rong-xin Chen13Yi Chen14Yi Chen15Yi Chen16Li-xin Li17Li-xin Li18Li-xin Li19Ning-ling Ge20Ning-ling Ge21Ning-ling Ge22Yu-hong Gan23Yu-hong Gan24Yu-hong Gan25Yan-hong Wang26Yan-hong Wang27Yan-hong Wang28Zheng-gang Ren29Zheng-gang Ren30Zheng-gang Ren31Department of Hepatic Oncology, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, ChinaKey Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, ChinaNational Clinical Research Center for Interventional Medicine, Shanghai, ChinaDepartment of Hepatic Oncology, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, ChinaKey Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, ChinaNational Clinical Research Center for Interventional Medicine, Shanghai, ChinaDepartment of Orthopedics, Zhongshan Hospital, Fudan University, Shanghai, ChinaDepartment of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, ChinaDepartment of Hepatic Oncology, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, ChinaKey Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, ChinaNational Clinical Research Center for Interventional Medicine, Shanghai, ChinaDepartment of Hepatic Oncology, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, ChinaKey Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, ChinaNational Clinical Research Center for Interventional Medicine, Shanghai, ChinaDepartment of Hepatic Oncology, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, ChinaKey Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, ChinaNational Clinical Research Center for Interventional Medicine, Shanghai, ChinaDepartment of Hepatic Oncology, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, ChinaKey Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, ChinaNational Clinical Research Center for Interventional Medicine, Shanghai, ChinaDepartment of Hepatic Oncology, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, ChinaKey Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, ChinaNational Clinical Research Center for Interventional Medicine, Shanghai, ChinaDepartment of Hepatic Oncology, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, ChinaKey Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, ChinaNational Clinical Research Center for Interventional Medicine, Shanghai, ChinaDepartment of Hepatic Oncology, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, ChinaKey Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, ChinaNational Clinical Research Center for Interventional Medicine, Shanghai, ChinaDepartment of Hepatic Oncology, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, ChinaKey Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Shanghai, ChinaNational Clinical Research Center for Interventional Medicine, Shanghai, ChinaBackgroundPatients 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.https://www.frontiersin.org/articles/10.3389/fonc.2021.671171/fullhepatocellular carcinoma (HCC)portal vein tumor thrombus (PVTT)transarterial chemoembolization (TACE)overall survival (OS)prognosismodel