ART Score:Evaluation Of Retreatment With TACE Suitability In Hepatocellular Carcinoma Patients

TACE is the first-line treatment for middle-stage hepatocellular carcinoma patients,but the stable liver function is the base.Typical HCC patients need to conduct more than three rounds of TACE treatments to obtain the best radiographic response.However,some patients may not benefit from TACE retreatment under some situations,TACE retreatment may lead to deterioration of liver function or elicit a poorer prognosis.ART(assessment for retreatment with TACE)score evaluates whether hepatocellular carcinoma(HCC)patients can benefit from transcatheter arterial chemoembolization(TACE)retreatments.As previously reported,TACE has a good prognostic effect on patients with ART score of 0-1.5,while patients with ART score≥2.5 might have minor or even no prognostic benefits.Objective: Our study verified whether ART score can guide multiple TACE retreatments in Chinese patients presenting with HCC.At the same time,according to the characteristics of hepatitis B in China,this paper focused on the analysis of hepatitis B patients.Methods: 934 patients presenting with HCC and treated with TACE were recruited from January 2008 to June 2012,at which point 137 patients had been treated with TACE at least twice and could be assessed by ART score.Patients were assessed by ART score before the second,third,and fourth TACE treatment,and divided into 0-1.5 group and≥2.5 group.Overall survival(OS)of both groups was compared,and patients were further evaluated on whether TACE retreatment was beneficial.At the same time,104 cases of 137 patients with hepatitis B patients were randomly divided into two groups,to further clarify the applicability of ART score in patients with hepatitis B.Results: Before the second,third,forth TACE treatment,the median OS(95% CI)was respectively 25.0(21.1 – 28.0)months,29.0(22.0 – 36.0)months and 24.3(8.2 – 40.4)months for patients with ART score 0 – 1.5.25.0(14.5 – 21.5)months,14.0(6.4 – 21.6)months and 22.0(11.8 – 32.3)months for patients with ART score ≥ 2.5.(P values were 0.036,0.011 and 0.152 respectively).Before second TACE treatment,the median OS(95% CI)was respectively 22.0(18.8-25.2)months,P=0.327,31.0,(3.2-58.8)months,P=0.329,24.0(13.4-34.6)months,P=0.001,in hepatitis B patients,hepatitis C patients and other causes patients.Conclusion: Our results are consistent with previous study that before TACE treatment,patients should be assessed by ART score,and those with ART score 0 – 1.5 had superior prognosis as compared those with an ART score ≥ 2.5,as indicated by statistically significant differences.But there was no significant difference between the two groups in hepatitis B patients with HCC.