Development Of Tace-Refractory Score For Tace In Hepatocellular Carcinoma

Background and Objective: Hepatocellular carcinoma(HCC)has been a severe health problem.Nearly 50% of HCC patients were in China.Transarterial chemoembolization(TACE)was standard treatment for patients in Barcelona Clinic Liver Cancer(BCLC)B stage.As a palliative treatment,TACE has its limitation.Then some articles have announced the definition of TACE refractory.We aimed to identify the independent risk factors for transarterial chemoembolization(TACE)refractory and develop a novel TACE-refractory score and nomogram for predicting TACE-refractory in hepatocellular carcinoma(HCC)patients treated with TACE.Methods: Between March 2006 and March 2016,patients with HCC who underwent TACE monotherapy as an initial treatment at two hospitals formed the training cohort and validation cohort,respectively.The criteria of TACE-refractory followed the Japan Society of Hepatology(JSH)2014 version of TACE-refractory.In the training cohort,we identified the independent risk factors of TACE-refractory and then developed TACE-refractory scores and nomogram.The accuracy of the systems was validated externally in the validation cohort.Results: In total,235 patients(training cohort: n=113;validation cohort: n=122)were included in this study.In the training cohort,82.3% of the patients(n=93)developed TACErefractory,with a median overall survival(OS)of 540 days(95%CI,400.8-679.1),whereas in the non-TACE-refractory group(n=20),median OS was 1257 days(95%CI,338.8-2175.2)(P =0.019).The median time and frequency of TACE for TACE-refractory were 207 days(95%CI,134.8-279.2)and 2 times of TACE since the 1st TACE.The independent risk factors for TACE-refractory were tumor number and bilobular invasion of HCC.The patients with TACE-refractory scores <3.5 had lower incidence of TACE-refractory compared with those scores >3.5 points(P<0.001).In the validation cohort,77.9% of the patients(n=95)developed TACE-refractory,with a median OS of 568 days(95%CI,416.3-719.7),whereas in the nonTACE-refractory group(n=27),median OS was 1324 days(95%CI,183.5-2464.5).Conclusions: TACE-refractory impairs the HCC patients' OS.The tumor number and bilobular invasion were independent risk factors for TACE-refractory.The TACE-refractory score and nomogram were effective tools and an easy approaches to predict the risk of TACE-refractory.