Association of Hepatoma Arterial-embolization Prognostic Score with Survival in Hepatocellular Carcinoma Patients undergoing Transcatheter Arterial Chemoembolization

Authors

  • Arfika Wida Ekacitta
  • Ulfa Kholili
  • Husin Thamrin
  • Poernomo Boedi Setiawan
  • Titong Sugihartono
  • Ummi Maimunah
  • Garry Prasetyo Adi
  • Made Bayu A. Rakateja

DOI:

https://doi.org/10.52783/jns.v14.2622

Keywords:

Hepatocellular carcinoma, transcahteter arterial chemoembolization, prognostic score, survival rate, mortality

Abstract

Introduction: Hepatocellular carcinoma (HCC) ranked as the third leading cause of cancer-related deaths worldwide. Hepatoma Arterial-embolization Prognostic (HAP) score was suggested as a survival predictor for HCC patients undergoing Transcatheter Arterial Chemoembolization (TACE).

Objectives: This study aimed to analyse the association of HAP score with survival in HCC patients undergoing TACE.

Methods: This was survival analysis with longitudinal study. The Kaplan-Meier curve was used for survival analysis, while Cox Regression test was used to analyse univariate and multivariate association between HAP score and its components to survival.

Results: There were 100 patients HCC who underwent TACE at a tertiary hospital between January 2019 and September 2022. The overall survival (OS) median was 7 months, while the 12-months survival rate was 9%. The 12-months survival rates of HAP A, HAP B, HAP C and HAP D were 25%, 23.3%, 0 and 0, respectively. There was association between HAP score and 12 months’ survival of HCC patients undergoing TACE (hazard ratio (HR) 3.187, 95% confidence interval (CI) 2.002–5.074, p<0.001).

Conclusions: HAP score has a prognostic value in predicting survival outcomes for HCC patients undergoing TACE.

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References

World Health Organization. Globocan 2020 Liver Cancer. World Health Organization, 2020.

Mittal S, El-Seraag HB. Epidemiology of HCC: Consider the Population. J Clin Gastroenterol. 2013; 47(0):S2–S6. doi: https://doi.org/10.1097/MCG.0b013e3182872f29.

Kementrian Kesehatan Republik Indonesia, Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/ MENKES/ 1355/ 2022 tentang Pedoman Nasional Pelayanan Kedokteran: Tata Laksana Karsinoma Sel Hati Pada Dewasa. Kementrian Kesehatan Republik Indonesia, 2022.

Waked I, Berhane S, Toyoda, H, Chan SL, Stern N, Palmer D, et al. Transarterial chemo-embolisation of hepatocellular carcinoma: Impact of liver function and vascular invasion. Br J Cancer. 2017; 116(4): 448–454. doi: https://doi.org/10.1038/bjc.2016.423.

Raoul JL, Forner A, Bolondi L, Cheung TT, Kloeckner R, de Baere T. Updated use of TACE for hepatocellular carcinoma treatment: How and when to use it based on clinical evidence. Cancer Treat Rev. 2019; 72:28–36. doi: https://doi.org/10.1016/j.ctrv.2018.11.002.

Kong JY, Li SM, Fan HY, Zhang L, Zhao HJ, Zhao HM. Transarterial chemoembolization extends long-term survival in patients with unresectable hepatocellular carcinoma. Medicine. 2018; 97(33):11872. doi: https://doi.org/10.1097/MD.0000000000011872.

Mishra G, Dev A, Paul E, Kemp W, Majeed A, Lubel J, et al. Prognostic factors associated with survival in patients with hepatocellular carcinoma undergoing transarterial chemoembolization: An Australian multicenter cohort study. Hepatoma Res. 2021; 7:56. doi: https://10.20517/2394-5079.2021.37.

Kadalayil L, Benini R, Pallan L, O’Beirne J, Marelli L, Yu D, et al. A simple prognostic scoring system for patients receiving transcatheter embolization for hepatocellular carcer. Ann Oncol. 2013; 24(10): 2565–2570. doi: https://doi.org/10.1093/annonc/mdt247.

Park Y, Kim SU, Kim BK, Park JY, Kim DY, Ahn SH, et al. Addition of tumor multiplicity improves the prognostic performance of the hepatoma arterial-embolization prognostic score. Liver Int. 2016; 36(1): 100–107. doi: https://doi.org/10.1111/liv.12878.

Dai QS, Gu HL, Ye S, Zhang YJ, Lin XJ, Lau WY, et al. Transarterial chemoembolization vs. conservative treatment for unresectable infiltrating hepatocellular carcinoma: A retrospective comparative study, Mol Clin Oncol. 2014; 2:1047–1054. doi: https://doi.org/10.3892/mco.2014.391.

Liu B, Liu BG, Yue T. The evaluation of the efficacy of transarterial chemotherapy and chemoembolization for primary hepatocellular carcinoma. Modern Medicine & Health, 2010; 2469–2470.

Ogasawara S, Chiba T, Ooka Y, Kanogawa N, Motoyama T, Suzuki E, et al. A prognostic score for patients with intermediate-stage hepatocellular carcinoma treated with transarterial chemoembolization. PLoS One. 2015; 10(4):e0125244. doi: https://doi.org/10.1371/journal.pone.0125244.

O’Suilleabhain CB, Poon RTP, Yong JL, Ooi GC, Tso WK, Fan ST. Factors predictive of 5-year survival after transarterial chemoembolization for inoperable hepatocellular carcinoma. Br J Surg, 2003; 90(3):325–331. doi: https://doi.org/10.1002/bjs.4045.

He S, Fan X, Ma, H, Xiaerfuhazi H, Rehato A, Feng J, et al. Effect of prophylactic TACE on 5-year survival of patients with hepatocellular carcinoma after hepatectomy. Oncol Lett. 2019; 18(2):1824–1830, 2019, doi: https://doi.org/10.3892/ol.2019.10517.

Wu JL, Luo JY, Jiang ZB, Huang SB, Chen GR, Ran HY, et al., Inflammation-related nomogram for predicting survival of patients with unresectable hepatocellular carcinoma received convertion therapy. World J Gastroenterol. 2023; 29(20):3168–3184. doi: https://doi.org/10.3748/wjg.v29.i20.3168.

Hasan I, Loho IM, Lesmana CRA, Gani RA, Siregar L, Waspodo AS, et al. Treatment for Intermediate-stage Hepatocellular Carcinoma: Current Practice and Outcome in Real World Study. INA-JGHE. 2022; 23(1):24–28. doi: https://doi.org/10.24871/231202224-28.

Putra AP, Sulaiman AS, Kurniawan J, Harimurti K. Factors Associated with Surveillance for Early Detection of Hepatocellular Carcinoma in Liver Cirrhosis Patients. INA-JGHE. 2018; 18(3)153–158. doi: https://doi.org/10.24871/1832017153-158.

Lee JS, Kim BK, Kim SU, Park JY, Ahn SH, Seong JS, et al. A survey on transarterial chemoembolization refractoriness and a real-world treatment pattern for hepatocellular carcinoma in Korea. Clin Mol Hepatol. 2020; 26(1):24–32. doi: https://doi.org/10.3350/cmh.2018.0065.

Zhu Y, Wang E, Zhao S, Han D, Zhao Y, Chen H, et al. Identify optimal HAP series scores for unresectable HCC patients undergoing TACE plus sorafenib: A Chinese multicenter observational study. Front Oncol. 2023; 12:983554. doi: https://doi.org/ 10.3389/fonc.2022.983554.

Yamada R, Kishi K, Sato M, Sonomura T, Nishida N, Tanaka K, et al. Transcatheter Arterial Chemoembolization (TACE) in the Treatment of Unresectable Liver Cancer. World J Surg. 1995; 19(6):795–800. doi: https://doi.org/10.1007/bf00299773.

Abdul Aziz NF, Yeoman A,Czajkowski M. Evaluating the utility of hepatoma arterial- embolization prognostic (HAP) score in clinical practice to provide prognosis of hepatocellular carcinoma (HCC) irrespective of treatment modalities. Eur J Surg Oncol. 2018; 44:S53. doi: https://doi.org/10.1016/j.ejso.2018.01.030.

Zhang H, Yuan SX, Dai SY, Zhang JM, Huang X, Lu CD, et al. Tumor size does not independently affect long-term survival after curative resection of solitary hepatocellular carcinoma without macroscopic vascular invasion. World J Surg. 2014; 38(4):947–957. doi: https://doi.org/10.1007/s00268-013-2365-2.

Jeong SO, Kim EB, Jeong SW, Jang JY, Lee SH, Kim SG, et al. Predictive factors for complete response and recurrence after transarterial chemoembolization in hepatocellular carcinoma. Gut Liver, 2017; 11(3):409–416. doi: https://doi.org/10.5009/gnl16001.

Yao FY, Ferrell L, Bass NM, Watson JJ, Bacchetti P, Venook A, et al. Liver transplantation for hepatocellular carcinoma: Expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001; 33(6):1394–1403. doi: https://doi.org/10.1053/jhep.2001.24563.

Ho SY, Liu PH, Hsu CY, Huang YH, Lei HJ, Liao JI, et al. Surgical resection versus transarterial chemoembolization for patients with hepatocellular carcinoma beyond Milan criteria: prognostic role of tumor burden score. Sci Rep. 2023; 13(1):13871. doi: https://doi.org/10.1038/s41598-023-41068-7.

Maimunah U, Restu AP, Nusi IA, Purbayu H, Sugihartono T, Kholili U, et al. Albumin-bilirubin grade as a three-month survival predictor in hepatocellular carcinoma patients after initial transarterial chemoembolization (ALBI grade predicting survival in HCC treated with TACE). Sys Rev Pharm. 2020; 11(5);205–208. doi: https://doi.org/10.31838/srp.2020.5.31.

Young S, Sanghvi T, Lake JJ, Rubin N, Golzarian, J. Predicting post-transarterial chemoembolization outcomes: A comparison of direct and total bilirubin serums levels. Diagn Interv Imaging. 2020; 101(6):355–364. doi: https://doi.org/10.1016/j.diii.2019.12.006.

Carr BI, Guerra V, Giannini EG, Farinati F, Ciccarese F, Rapaccini GL, et al. Association of abnormal plasma bilirubin with aggressive hepatocellular carcinoma phenotype. Semin Oncol. 2014; 41(2):252–258. doi: https://doi.org/10.1053/j.seminoncol.2014.03.006.

Carr BI, Guerra V. Serum albumin levels in relation to tumor parameters in hepatocellular carcinoma patients. Int J Biol Markers, 2017; 32(4):e391–e396. doi: https://doi.org/10.5301/ijbm.5000300.

Jeng LB, Chan WL, Teng CF. Prognostic Significance of Serum Albumin Level and Albumin-Based Mono- and Combination Biomarkers in Patients with Hepatocellular Carcinoma, Cancers (Basel), 2023; 15(4):1005. doi: https://doi.org/10.3390/cancers15041005.

Bai DS, Zhang C, Chen P, Jin SJ, Jiang GQ.The prognostic correlation of AFP level at diagnosis with pathological grade, progression, and survival of patients with hepatocellular carcinoma. Sci Rep. 2017; 7(1):12870. doi: https://doi.org/10.1038/s41598-017-12834-1.

Mishra G, Dev A, Paul E, Cheung W, Koukounaras J, Jhamb A, et al. Prognostic role of alpha-fetoprotein in patients with hepatocellular carcinoma treated with repeat transarterial chemoembolization. BMC Cancer. 2020; 20 (1):483. doi: https://doi.org/10.20517/2394-5079.2021.37.

Heng C, Peng W, Liu X, Li C, Li X, Wen TF. Post-treatment alpha-fetoprotein response predicts prognosis of patients with hepatocellular carcinoma: A meta-analysis. Medicine (United States). 2019; 98(31):e16557. doi: https://doi.org/10.1097/MD.0000000000016557.

Wang XY, Wang EX, Bai W, Xia DD, Mu W, Li J, et al., Validation and evaluation of clinical prediction systems for first and repeated transarterial chemoembolization in unresectable hepatocellular carcinoma: A Chinese multicenter retrospective study. World J Gastroenterol. 2020; 26(8):657–669. doi: https://doi.org/10.3748/wjg.v26.i6.657.

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Published

2025-03-26

How to Cite

1.
Ekacitta AW, Kholili U, Thamrin H, Boedi Setiawan P, Sugihartono T, Maimunah U, Prasetyo Adi G, Rakateja MBA. Association of Hepatoma Arterial-embolization Prognostic Score with Survival in Hepatocellular Carcinoma Patients undergoing Transcatheter Arterial Chemoembolization. J Neonatal Surg [Internet]. 2025Mar.26 [cited 2025Sep.20];14(9S):15-22. Available from: https://jneonatalsurg.com/index.php/jns/article/view/2622