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[ART score prognostic significance in patients with intermediate hepatocellular carcinoma]
Insights
The ART score effectively stratifies patients with stage B hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization, identifying subgroups with significantly different overall survival (OS) and informing treatment decisions.
Area of Science:
- Hepatobiliary Medicine
- Oncology
- Interventional Radiology
Background:
- Transarterial chemoembolization (TCE) is a standard palliative treatment for stage B hepatocellular carcinoma (HCC) per the Barcelona Clinic Liver Cancer (BCLC) classification.
- The BCLC stage B group is heterogeneous, necessitating better tools for patient stratification and treatment guidance.
- The ART score was developed to refine patient selection for repeated TCE cycles.
Purpose of the Study:
- To validate the ART score's ability to differentiate overall survival (OS) in patients with BCLC stage B HCC receiving repeated TCE.
- To assess if the ART score can identify subgroups with distinct prognoses within the BCLC stage B HCC population.
Main Methods:
- A combined retrospective and prospective study design was employed.
- Patient data were collected from the Internal Medicine Clinic of the First Faculty of Medicine, Charles University in Prague, and the Central Military Hospital Prague.
- Overall survival (OS) analysis utilized the Kaplan-Meier method with R software.
Main Results:
- The median OS for the entire cohort was 18 months.
- Patients with a favorable ART score demonstrated a median OS of 33 months, significantly longer than the 12 months for those with an unfavorable ART score (p < 0.01).
- The ART score proved effective in distinguishing prognostically different subgroups within BCLC stage B HCC.
Conclusions:
- The ART score is a valuable tool for stratifying BCLC stage B HCC patients based on predicted overall survival after repeated TCE.
- Current treatment guidelines for BCLC stage B HCC may require revision to incorporate the prognostic insights provided by the ART score.
- Personalized treatment strategies for HCC can be enhanced by utilizing the ART score for patient selection and prognosis assessment.
Abstract:
Palliative transarterial chemoembolization is indicated for patients with stage B hepatocellular carcinoma (HCC) based on the Barcelona Clinic Liver Cancer classification (BCLC). As this is a very wide and heterogenous group of patients, the ART score was designed to better differentiate these patients and to guide the decision for a second transarterial chemoembolization cycle.The goal of the study is to prove that the ART score is appropriate to define subgroups within the stage BCLC-B HCC group with significantly better or worse overall survival (OS) after repeated transarterial chemoembolization. A combined retrospective and prospective study was performed of the OS of patients with stage BCLC-B HCC that were monitored and treated at the Internal Medicine Clinic of the First Faculty of Medicine, Charles University in Prague and the Central Military Hospital Prague. An analysis of the survival curve using the Kaplan-Meier method was performed using the R software package.The median OS of the entire patient group was 18 months (95% CI 12-33). The median OS of patients with a favorable ART score was 33 months (95% CI 12-33) compared to 12 months (95% CI 6-18) for patients with an unfavorable ART score. The difference in OS in the subgroups differentiated by ART score was statistically significant (p < 0.01). Due to the significant difference in OS of patients differentiated by ART score, the currently recommended guidelines for the treatment of patients with stage BCLC-B hepatocellular carcinoma should be revised.
