1. The ART of Decision Making : Retreatment with Transarterial Chemoembolization in Patients with Hepatocellular Carcinoma
Wolfgang Sieghart, Florian Hucke, Matthias Pinter, Ivo Graziadei, Wolfgang Vogel, Christian Muller,
Harald Heinzl, Michael Trauner, and Markus Peck-Radosavljevic
Hepatology 2013 Jan 12. doi: /hep.26256
소화기내과 R3 이태인 / Prof.심재준

2. Backgrounds
HCC is the fifth most common cancer worldwide, and develops predominately in patients with liver cirrhosis
TACE is the recommended treatment modality for asymptomatic, large, or multifocal HCC without macrovascular invasion or extahepatic metastasis

3. Deterioration of liver function after TACE may negatively impact the patients prognosis and liver function may further worsen after repeated TACE
The aim of this study was to estabilish a clinically usable point score to guide the decision for retreatment with TACE in patients with HCC

4. Materials and Methods - Eligibility

5. Materials and Methods – Collecting date
BCLC, UICC-TNM staging
Baseline imaging (tri-phasic CT/MRI) was performed 5~7 days before the first TACE session
Patients with complete remission(CR) after the first TACE did not included into this study analysis
All laboratory values that mean liver function parameters including the Child-Pugh score were determined 1 day before the TACE-1,2

6. Adverse events that occurred within 4 weeks after TACE were documented
AFP response was defined as an AFP decrease by 50% from pre-TACE-1 values of ≥ 200 kU/L
Pre-TACE-1 AFP ≥ 200 kU/L with response
Pre-TACE-1 AFP ≥ 200 kU/L and no response
Pre-TACE-1 AFP levels < 200 kU/L
Elevated CRP values have a strong prognostic significance for HCC patients
CRP values < 1 mg/dL prior the TACE-2
CRP values ≥ 1 mg/dL prior the TACE-2
Adverse events that occurred within 4 weeks after TACE were documented

7. Materials and Methods – Study design and Statistical Analysis

8. Results – Patients Characteristics

9. Results – Univariate analysis of prognostic factors in the training cohort

10. Results – Stepwise Cox Regression Model woth All Factors Predicting OS in the Training Cohort

11. Results – ART Score Predicts OS in the Training and the Validation Cohort
23.7 months
6.6 months

13. Results – ART Score Predicts OS in Several Clinical Subgroups
C-P score A prior TACE-2
Ascites prior TACE-2
C-P score B7 prior TACE-2
Normal prior TACE-2
C-P score ≥ 8 prior TACE-2
Elevated CRP prior TACE-2

15. Conclusion
An ART score of ≥ 2.5 prior the second TACE identifies patients with a dismal prognosis who may not profit from further TACE sessions