P-ART Score is a New Modification to Improve ART Score Predictive Accuracy for Patients with HCC Undergoing TACE

Predicting the prognosis of patients with HCC is challenging.

To evaluate the Assessment for Retreatment with TACE (ART) score in predicting survival after TACE retreatment and the value of adding post-TACE thrombocytopenia in improving its accuracy (P-ART).

Barcelona Clinic Liver Cancer (BCLC) stages A and B patients underwent TACE retreatment, and records were reviewed. Radiologic tumor response (RTR) after the first TACE was considered a partial response, while the absence of response is a stable or progressive disease. The one year overall survival (OS) from the second TACE was determined.

One hundred and sixty patients included 88.1% men, age 60.7±7.2 years, Child-Pugh class A&B cirrhosis (n=133 and 27, respectively), mostly hepatitis C (96.3%), with BCLC-A&B (n=74 and 86, respectively). RTR was present in 82 patients. Variables associated with poor OS: baseline lower serum albumin and platelet count, besides follow-up absent radiologic tumor response, an increase in AST >25%, an increase in Child-Pugh score, and a fall in platelet count fall ≥10,000/mL³ before TACE2. By multivariate analysis, ART score parameters and platelet count fall were independent predictors of poor survival. RTR absence had the higher risk of mortality by 3.12 times than responding tumors. ART score subgroups (≤1.5 and ≥2.5 points, 81 and 79 patients, respectively) had no significant relation to OS (22.3 vs 16.7 months; P=0.07). On modifying the ART score by adding 3 points for fallen platelet count ≥10,000/mL³ (ART-P score), 113 patients scored 0-5 and 47 scored ≥5.5 with a median OS of 22 vs 11.2 months, respectively (P=0.01).

ART score could not identify patients who will benefit from TACE retreatment in intermediate-stage HCC patients, and the addition of platelet count reduction (P-ART) could improve its prognostic ability.