Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2021; 9(18): 4559-4572
Published online Jun 26, 2021. doi: 10.12998/wjcc.v9.i18.4559
Expected outcomes and patients’ selection before chemoembolization—“Six-and-Twelve or Pre-TACE-Predict” scores may help clinicians: Real-life French cohorts results
Xavier Adhoute, Edouard Larrey, Rodolphe Anty, Patrick Chevallier, Guillaume Penaranda, Albert Tran, Jean-Pierre Bronowicki, Jean-Luc Raoul, Paul Castellani, Hervé Perrier, Olivier Bayle, Olivier Monnet, Bernard Pol, Marc Bourliere
Xavier Adhoute, Paul Castellani, Hervé Perrier, Marc Bourliere, Department of Gastroenterology and Hepatology, Hôpital Saint-Joseph, Marseille 13008, France
Edouard Larrey, Rodolphe Anty, Albert Tran, Department of Gastroenterology and Hepatology, Hôpital Universitaire de l’Archet, Nice 06000, France
Patrick Chevallier, Department of Radiology, Hôpital Universitaire de l’Archet, Nice 06000, France
Guillaume Penaranda, Statistics Department, AlphaBio Laboratory, Marseille 13003, France
Jean-Pierre Bronowicki, Department of Gastroenterology and Hepatology, Centre Hospitalo-Universitaire de Nancy, Vandoeuvre les Nancy 54511, France
Jean-Luc Raoul, Department of Medical Oncology, Institut de Cancérologie de l’Ouest, Site de Nantes, Nantes 44805, France
Olivier Bayle, Olivier Monnet, Department of Radiology, Hôpital Saint-Joseph, Marseille 13008, France
Bernard Pol, Department of Hepatobiliary Surgery, Hôpital Saint-Joseph, Marseille 13008, France
Author contributions: Adhoute X, Larrey E, Tran A, Bourliere M, Anty R, Castellani P, Perrier H, Pol B and Bronowicki JP were the physicians in charge of the patients; Chevallier P, Monnet O and Bayle O were the radiologists who performed endovascular treatments; Adhoute X, Larrey E, Bourliere M and Bronowicki JP collected the data and Penaranda G proceeded to statistical analysis; Adhoute X, Bourliere M, Larrey E, Raoul JL and Anty R wrote the manuscript.
Institutional review board statement: This study did not involve humans, but only the reuse of already recorded data. Since this study was based on a retrospective analysis of clinical data, the Institutional and Ethical Review Board of the Hôpital Saint-Joseph waived requirement for informed patient consent and approved the study.
Informed consent statement: Since this study was based on a retrospective analysis of clinical data, the Institutional Review Board waived requirement for informed patient consent; the Ethics Committee of our institution (Hôpital Saint-Joseph) authorized us to carry out this work.
Conflict-of-interest statement: The authors have no potential conflict of interest relative to this article. Adhoute X: Board member (Bayer, Ipsen, Eisai); Grant from Ipsen, Eisai. Anty R: Board member (Gilead, Bayer, Eisai, Intercept, Abbvie, MSD, Ipsen). Chevallier P: Board member (Bayer). Tran A: Board member (Gilead, Bayer, Eisai, Intercept, Abbvie, MSD, Ipsen). Bronowicki JP: Board member (Merck-Schering Plough, Janssen, Roche, BMS, Boehringer-Ingelheim, Gilead, Novartis, GSK, Bayer). Raoul JL: Board member (Bayer, BMS, Daichi). Castellani P: Board member (Gilead). Bourlière M: Board member (Merck-Schering Plough, Gilead, Janssen, Vertex, Boehringer-Ingelheim, BMS, Roche, Abbvie, GSK). Pénaranda G, Perrier H, Monnet O, Bayle O and Pol B have no conflict of interest.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xavier Adhoute, Doctor, Department of Gastroenterology and Hepatology, Hôpital Saint-Joseph, 26 Bd de Louvain, Marseille 13008, France. xvadhoute@gmail.com
Received: November 7, 2020
Peer-review started: November 7, 2020
First decision: December 13, 2020
Revised: December 26, 2020
Accepted: February 4, 2021
Article in press: February 4, 2021
Published online: June 26, 2021
ARTICLE HIGHLIGHTS
Research background

Transarterial chemoembolization (TACE) is currently recommended for intermediate stage hepatocellular carcinomas (HCCs), while in practice TACE is performed beyond the recommendations. New therapeutic options in advanced HCC require careful selection of patients prior to TACE treatment, since some patients may not benefit from this therapy and may impair their liver function.

Research motivation

Two recently developed models entitled "pre-TACE-predict” and “Six-and-Twelve” both easy-to-use and powerful, have been designed accordingly, to identify suitable and inappropriate candidates and thus help in the decision-making process.

Research objectives

To evaluate and compare the performance of both new models in survival prediction, and their potential contribution to patient treatment strategy.

Research methods

This is a retrospective multicenter study performed on two French cohorts with HCC of different stages, including 324 patients classified as Barcelona Clinic Liver Cancer (BCLC) stages A/B (cohort 1) and 137 patients classified as BCLC stages B/C (cohort 2), respectively. All of these patients (treatment naïve or with recurrence after curative therapies) received conventional TACE treatment as the main therapy during a period from 01/2010 to 12/2018. Survival prediction was calculated based on these two new models and compared to the BCLC system and established prognostic scores [Albumin-Bilirubin grade, NIACE (Number of tumor, Infiltrative HCC, Child-Pugh, Alpha-fetoprotein, Eastern Cooperative Oncology Group Performance Status)] using concordance-index and area under the receiver operating characteristic curve across time.

Research results

The "pre-TACE-predict" model identified three rather than four groups of patients with different prognosis within a recommended TACE candidate cohort (cohort 1), similar to the “6 and 12” model. Its prognostic value was no higher than other systems, as opposed to the "post-TACE-predict" model that includes response to treatment. The contribution of both new models was reduced in our second cohort with advanced stage HCCs (cohort 2), as prognosis is influenced by variables other than tumor size or number and TACE efficacy is unclear in HCC with vascular invasion.

Research conclusions

Both “pre-TACE-predict” and “6 and 12” models offer an interesting stratification into three groups in a recommended TACE population, by defining respectively a first group with durable control but prone to recurrence, a second partially controlled group prone to progression and a third group that do not benefit from this treatment.

Research perspectives

With further refinement prior to chemoembolization, the “6 and 12” and “pre-TACE-predict” models allow us to consider the future scenarios of TACE therapy with (1) HCC patients who might benefit from adjuvant therapy to prevent recurrence (after a complete response to TACE); (2) others who might benefit from a combined therapy following a partial response to TACE; and (3) others who should be treated with a systemic exclusive therapy.