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

Op Den Winkel M, Nagel D, Op Den Winkel P, Paprottka PM, Schmidt L, Bourhis H, Trojan J, Göller M, Reiter FP, Stecher SS, De Toni EN, Gerbes AL, Kolligs FT (2019)

Publication Type: Journal article

Publication year: 2019

Journal

Digestion Karger

Book Volume: 100

Pages Range: 15-26

Journal Issue: 1

DOI: 10.1159/000493136

Abstract

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.

Authors with CRIS profile

Markus Göller Department of Medicine 2 – Cardiology and Angiology

Involved external institutions

Klinikum der Universität München (Großhadern und Innenstadt) DE Germany (DE) Klinikum der Universität München DE Germany (DE) Krankenhaus Nordwest DE Germany (DE) Goethe-Universität Frankfurt am Main DE Germany (DE)

How to cite

APA:

Op Den Winkel, M., Nagel, D., Op Den Winkel, P., Paprottka, P.M., Schmidt, L., Bourhis, H.,... Kolligs, F.T. (2019). The Munich-Transarterial Chemoembolisation Score Holds Superior Prognostic Capacities Compared to TACE-Tailored Modifications of 9 Established Staging Systems for Hepatocellular Carcinoma. Digestion, 100(1), 15-26. https://doi.org/10.1159/000493136

MLA:

Op Den Winkel, Mark, et al. "The Munich-Transarterial Chemoembolisation Score Holds Superior Prognostic Capacities Compared to TACE-Tailored Modifications of 9 Established Staging Systems for Hepatocellular Carcinoma." Digestion 100.1 (2019): 15-26.

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