Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2018; 24(15): 1641-1649
Published online Apr 21, 2018. doi: 10.3748/wjg.v24.i15.1641
Analysis of aggressiveness factors in hepatocellular carcinoma patients undergoing transarterial chemoembolization
Yossi Ventura, Brian I Carr, Issac Kori, Vito Guerra, Oren Shibolet
Yossi Ventura, Oren Shibolet, Liver Unit, Department of Gastroenterology and Hepatology, Tel-Aviv Medical Center, Tel-Aviv 62431, Israel
Yossi Ventura, Oren Shibolet, Sackler faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel
Brian I Carr, Izmir Biomedicine and Genome Center, Dokuz Eylul University, Izmir 35340, Turkey
Issac Kori, Interventional Radiology, Division of Imaging Tel Aviv Medical Center, Tel-Aviv 62431, Israel
Vito Guerra, Department of Clinical Trials and Epidemiology, IRCCS de Bellis, Castellana Grotte 70013, Italy
Author contributions: All authors equally contributed to this manuscript.
Institutional review board statement: The Tel-Aviv medical center database management conforms to Israeli legislation on privacy and this study was approved by the institutional research committee in Tel-Aviv Medical Center (Approval number: 0528-16-TLV) in accordance with the ethical standards of the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent statement: Our manuscript is a retrospective study, therefore an informed consent waver was given by the IRB. Data was anonymized to prevent identification.
Conflict-of-interest statement: Professor Shibolet has nothing to disclose.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at Consent was not obtained but the presented data are anonymized and there is no risk of patient identification. The potential benefits of sharing these data outweigh the potential harms because of its possible application in improving future identification and treatment of HCC.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Oren Shibolet, MD, Liver Unit, Department of Gastroenterology and Hepatology, Tel-Aviv Medical Center, 14 Weizman Street, Tel-Aviv 62431, Israel.
Telephone: +972-3-6973984 Fax: +972-3-6974622
Received: January 3, 2018
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
Research background

Hepatocellular carcinoma (HCC) is a common and deadly cancer. Transterial chemoembolization (TACE) is the treatment of choice for non-operable, intermediate stage HCC.

Research motivation

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.

Research objective

To identify novel biomarkers to predict survival following TACE and combine them with the AgI.

Research methods

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.

Research results

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.

Research conclusions

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.

Research prospective

This novel score can be used to assess prognosis in HCC undergoing TACE.