Model Predicting Survival in Intermediate-Stage HCC Patients Reclassified for TACE Based on the 2022 BCLC Criteria

Area of Science:

• Hepatology
• Oncology
• Radiology

Background:

• The 2022 Barcelona Clinic Liver Cancer (BCLC) staging system update refined hepatocellular carcinoma (HCC) patient stratification.
• Transarterial chemoembolization (TACE) is a primary treatment for intermediate-stage HCC (BCLC B).
• A prognostic model for survival outcomes in TACE candidates under the updated BCLC criteria is lacking.

Purpose of the Study:

• To develop a pretreatment risk prediction model for overall survival (OS).
• To identify factors predicting OS in intermediate-stage HCC patients eligible for TACE based on the 2022 BCLC guidelines.

Main Methods:

• Retrospective analysis of 658 HCC patients receiving first-line TACE.
• Evaluation of pretreatment factors: Child-Pugh score, tumor burden (up-to-11 criteria), bilobar involvement, and alpha-fetoprotein (AFP).
• Cox proportional hazards models used for predictor identification and risk model development.

Main Results:

• Significant OS predictors identified: Child-Pugh score ≥ 7, bilobar involvement beyond up-to-11 criteria, and AFP ≥ 400 ng/mL.
• A risk model stratified patients into low, intermediate, and high-risk groups.
• Median OS: 53 months (low-risk), 35 months (intermediate-risk), and 21 months (high-risk).

Conclusions:

• The developed risk model aids in predicting OS for intermediate-stage HCC patients.
• This model can guide TACE candidacy decisions aligned with the 2022 BCLC guidelines.
• The model offers valuable prognostic information for HCC management.