The Study Of ART Scoring System Guiding Repeated Transarterial Chemoembolization In HCC Patients

Objective The study was to validate the effectiveness of ART scoring system in the overall survival of Hepatocellular Carcinoma(HCC)patients who underwent transarterial chemoembolization(TACE)and guide TACE retreatment.Methods Between Jan 2005 and Jan 2014,54 patients with HCC underwent?2 TACE sessions within 90 days at our Hospital,we calculated the ART score.Then the patient population was divided into two groups:low score group(0-1.5),high score group(?2.5)They were investigated for their performance of the ART score in the context of overall survival(OS).Results Among the 54 patients,36 were male(70.4%);18 were female(29.6%),42 were ? 60 years old(77.8%);12 were <60 years old(22.2%),45 had hepatitis B virus infection(83.3%);non-hepatitis B virus infection in 9(16.7%)cases.All the patients performance status score were 0 or 1 points.Pre-TACE1,15(27.8%)and 39(72.2%)patients were classified as having Child-Pugh class A,B tumors.20(37%),31(57.6%),and 3(5.6%)patients were staged with BCLC A,BCLC B,and BCLC C tumors.the average of AFP was 447(3.8-1210)ng/ml,and the average AST was 62.2(27.1-124.6)u/l.Pre-TACE2,13(24.1%)patients experienced an AST increase of >25%.11(20.4%),37(68.5%)and 6(11.1%)patients were classified as Child-Pugh A,B and C.According to the m RECIST standard,36(66.7%),11(20.4%)and 7(12.9%)patients were classified as PR(partial response),SD(stable disease)and PD(progressive disease),indicated that 18(33.2%)had no radiological tumor response.The Child-Pugh score increased 1 point in 7(12.9%),and 2 pionts in 4(7.5%)patients.According to the ART scoring system,the low score group was 37(0-1.5)patients and the high score group was 17(?2.5)patients.The study showed that the 6-,12-,and 18-month overall survival rates of the high score group were 52.9%,47.1%,35.3%,and the low score group were 94.6%,81.1% and 67.6%,respectively.The median OS of all the patients was 20.2 months.We compared the OS between the low and the high score group using Kaplan-Meier estimates,the comparisons of the survival curves showed that the median OS was(23.7 ± 2.2)months(95% CI:19.3-28.0)in the low ART score group and(7.5 ± 2.8)months(95% CI:1.9-13.1)in the high ART score group(p<0.001).At univariate analysis,Child-Pugh score pre-TACE-2(p = 0.021)and radiological tumor response(p < 0.001)had statistical impact on survival,they were entered into a Cox regression analysis,Multivariate Cox regression analysis showed that radiological tumor response(HR = 2.94,95% CI: 1.47-6.31,p = 0.001)was significantly associated with OS.Conclusion ART scoring system would be a suitable prediction for the overall survival of HCC patients who underwent ? 2 TACE sessions within 90 days in China,and guide clinicians when to terminate TACE.Besides,radiologic tumor response is an independent prognostic factor of HCC patients.