Tumor burden with AFP improves survival prediction for TACE-treated patients with HCC: An international observational study☆

作者：Dongdong Xia, Wei Bai, Qiuhe Wang, Jin Wook Chung, Xavier Adhoute, Roman Kloeckner, Hui Zhang, Yong Zeng, Pimsiri Sripongpun, Chun‐Hui Nie, Seung Up Kim, Ming Huang, Wenhao Hu, Xiangchun Ding, Guowen Yin, Hailiang Li, Hui Zhao, Jean–Pierre Bronowicki, Jing Li, Jiaping Li, Xiaoli Zhu, Jianbing Wu, Chunqing Zhang, Weidong Gong, Zixiang Li, Zhengyu Lin, Tao Xu, Tao Yin, Rodolphe Anty, Jinlong Song, Hai‐Bin Shi, Guoliang Shao, Wei‐Xin Ren, Yongjin Zhang, Shufa Yang, Yanbo Zheng, Jian Xu, Wenhui Wang, Xu Zhu, Ying Fu, Chang Liu, Apichat Kaewdech, Rong Ding, Jie Zheng, Shuaiwei Liu, Hui Yu, Zheng Lin, Nan You, Wenzhe Fan, Shuai Zhang, Long Feng, Guangchuan Wang, Peng Zhang, Xueda Li, Jian Chen, Feng Zhang, Wenbo Shao, Wei-Zhong Zhou, Hui Zeng, Gengfei Cao, Wukui Huang, Wenjin Jiang, Wen Zhang, Lei Li, Aiwei Feng, Enxin Wang, Zhexuan Wang, Dandan Han, Yong Lv, Jun Sun, Bincheng Ren, Linying Xia, Xiaomei Li, Jie Yuan, Zheng‐Yu Wang, Bohan Luo, Kai Li, Wengang Guo, Zhanxin Yin, Yan Zhao, Jielai Xia, Daiming Fan, Kaichun Wu, Dominik Bettinger, Arndt Vogel, Guohong Han · 发表于：JHEP Reports · 年份：2024 · DOI：10.1016/j.jhepr.2024.101216 · 被引用次数：11 · 研究领域：Hepatocellular Carcinoma Treatment and Prognosis、Liver Disease Diagnosis and Treatment、Intraperitoneal and Appendiceal Malignancies

Background & Aims Current prognostic models for patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE) are not extensively validated and widely accepted. We aimed to develop and validate a continuous model incorporating tumor burden and biology for individual survival prediction and risk stratification. Methods Overall, 4,377 treatment-naive candidates for whom TACE was recommended, from 39 centers in five countries, were enrolled and divided into training, internal validation, and two external validation datasets. The novel model was developed using a Cox multivariable regression analysis and compared with our original 6-and-12 model (the largest tumor size [ts, centimetres] + tumor number [tn]) and other available models in terms of predictive accuracy. Results The proposed model, named the ‘6-and-12 model 2.0', was generated as ‘ts + tn + 1.5×log 10 alpha-fetoprotein (AFP)', showed good discrimination (C-index 0.674) and calibration (Hosmer–Lemeshow test p = 0.147), and outperformed current existing models. An easy-to-use stratification was proposed according to the different AFP levels (≤100, 100–400, 400–2,000, 2,000–10,000, 10,000–40,000, and >40,000 ng/ml) along with the corresponding tumor burden cutoffs (8/14, 7/13, 6/12, 5/11, 4/10, and any tumor burden); that is, if the AFP level was 400–2,000 ng/ml, the stratification should be low-(≤6)/intermediate-(6–12)/high-risk (>12) strata. Hence, it could divide the patients into thre...