The Munich-Transarterial Chemoembolisation Score Holds Superior Prognostic Capacities Compared to TACE-Tailored Modifications of 9 Established Staging Systems for Hepatocellular Carcinoma.

Autor:	Op den Winkel M; Department of Medicine II, Liver Center Munich, University Hospital, Munich, Germany, mark.op.den.winkel@med.uni-muenchen.de., Nagel D; Institute of Laboratory Medicine, University Hospital, Munich, Germany., Op den Winkel P; Department of Internal Medicine, Krankenhaus Nordwest, Frankfurt am Main, Germany., Paprottka PM; Department of Clinical Radiology, University Hospital, Munich, Germany., Schmidt L; Department of Medicine II, Liver Center Munich, University Hospital, Munich, Germany., Bourhis H; Department of Medicine II, Liver Center Munich, University Hospital, Munich, Germany., Trojan J; Department of Internal Medicine I, Johann-Wolfgang-Goethe-University, Frankfurt am Main, Germany., Goeller M; Department of Internal Medicine II, University of Erlangen, Erlangen, Germany., Reiter FP; Department of Medicine II, Liver Center Munich, University Hospital, Munich, Germany., Stecher SS; Department of Medicine II, Liver Center Munich, University Hospital, Munich, Germany., De Toni EN; Department of Medicine II, Liver Center Munich, University Hospital, Munich, Germany., Gerbes AL; Department of Medicine II, Liver Center Munich, University Hospital, Munich, Germany., Kolligs FT; Department of Medicine II, Liver Center Munich, University Hospital, Munich, Germany.; Department of Internal Medicine and Gastroenterology, Helios-Klinikum Berlin-Buch, Berlin, Germany.
Jazyk:	angličtina
Zdroj:	Digestion [Digestion] 2019; Vol. 100 (1), pp. 15-26. Date of Electronic Publication: 2018 Oct 03.
DOI:	10.1159/000493136
Abstrakt:	Background/aims: The recently proposed Munich-transarterial chemoembolisation-score (M-TACE) was tailored to suit hepatocellular Carcinoma (HCC) patients evaluated for TACE. M-TACE outperformed the established HCC-staging-systems and successfully passed external validation. Modifications of staging-systems through the rearrangement of stages or by adding prognostic factors are methods of improving prognostic power. M-TACEs performance compared to scores modified this way should be tested. Methods: Seven well-known HCC staging-systems (including Cancer of the Liver Italian Program-score [CLIP] and Barcelona Clinic liver cancer [BCLC]) and 2 TACE-specific scores (Selection for Transarterial Chemoembolisation Treatment [STATE] and Hepatoma Arterial embolisation Prognostic [HAP]) were rearranged in a cohort of 186 TACE-patients through score-point-analysis and subsequent linking of non-significant adjacent score-points. Additionally, a new score was constructed by combining the top established staging-system in TACE patients (CLIP-TACE) and the prognostic parameter with the highest hazard ratio for death in the TACE-cohort [C-reactive protein (CRP)]. Additionally, the TACE-tailored-scores were applied to an external TACE-cohort (n = 71). -Results: Rearrangement resulted in optimal stratification and monotonicity. CLIP-TACE demonstrated the best prognostic capability of all rearranged scores (c-index 0.668, AIC 1294) and the addition of CRP yielded further prognostic improvement (c-index 0.680, AIC 1289). However, superiority over M-TACE could not be achieved by any of the new scores in the internal and external cohort. Conclusion: M-TACE outperforms TACE-tailored modifications of all relevant HCC-staging-systems. Prospective validation of M-TACE to promote its role as the preferred staging-system for TACE-patients is therefore justified. (© 2018 S. Karger AG, Basel.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu