Published online Apr 21, 2018. doi: 10.3748/wjg.v24.i15.1641
Peer-review started: January 4, 2018
First decision: January 16, 2018
Revised: March 10, 2018
Accepted: March 25, 2018
Article in press: March 25, 2018
Published online: April 21, 2018
Hepatocellular carcinoma (HCC) is a common and deadly cancer. Transterial chemoembolization (TACE) is the treatment of choice for non-operable, intermediate stage HCC.
There is a need to identify prognostic indices in HCC patients undergoing TACE. An “HCC aggressiveness index (AgI)” incorporates 4 tumor-related parameters: maximum tumor diameter (MTD), number of tumor nodules, portal vein thrombosis (PVT) and serum alpha fetoprotein (AFP) levels. This score predicts survival in HCC patients.
To identify novel biomarkers to predict survival following TACE and combine them with the AgI.
We retrospectively analyzed data from 167 patients with HCC that underwent TACE at Tel-Aviv Medical center from 2000 to 2015. Baseline tumor parameters including: maximum tumor diameter, number of tumor nodules and presence of PVT; labs including: blood count; routine liver function tests and plasma AFP levels; demographics and overall survival information were all collected. The Cox proportional hazards model was applied to identify the correlation of AgI with overall survival and analyze laboratory factors’ associated with the AgI.
The AgI was correlated with survival. The 3-year survival probability for AgI of > 4 vs < 4 was 42.4% vs 61.8%; P < 0.0863, from the time of diagnosis by Kaplan-Meier plot. Moreover, According to the univariate Cox proportional hazard model for mortality with AgI score of > 4, there was a HR of 2.18 (95%CI: 1.108-4.310, P < 0.024). We found that only GGTP levels and the AgI were independently associated with survival of the HCC patients following TACE.
AgI was validated as a useful predictor of survival in HCC patients undergoing TACE. Combining the AgI with liver function parameters may improve its prognostic yield in this patient population.
This novel score can be used to assess prognosis in HCC undergoing TACE.