J Cancer 2020; 11(15):4589-4596. doi:10.7150/jca.44847 This issue Cite

Research Paper

A Novel Pre-treatment Model Predicting Risk of Developing Refractoriness to Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma

Keshu Hu1,*, Shenxin Lu1,*, Miao Li1,*, Feng Zhang1, Bei Tang1, Jia Yuan1, Yan Shan2, Pengju Xu2, Rongxin Chen1, Zhenggang Ren1, Xin Yin1✉

1. Liver Cancer Institute & Zhongshan Hospital, Fudan University, Shanghai, China; Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education
2. Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
*These authors contributed equally to this paper.

Citation:
Hu K, Lu S, Li M, Zhang F, Tang B, Yuan J, Shan Y, Xu P, Chen R, Ren Z, Yin X. A Novel Pre-treatment Model Predicting Risk of Developing Refractoriness to Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma. J Cancer 2020; 11(15):4589-4596. doi:10.7150/jca.44847. https://www.jcancer.org/v11p4589.htm
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Abstract

Background and aim: Refractoriness to transarterial chemoembolization is common during the therapeutic process of hepatocellular carcinoma, which is an intractable issue and may compromise the prognosis. We aim to establish a pre-treatment model to identify patients with high risks of refractoriness.

Methods: From 2010 to 2016, 824 treatment-naive patients who had initially underwent at least two sessions of transarterial chemoembolization in Zhongshan Hospital, Fudan University were retrospectively enrolled. These patients were randomly allocated into a training cohort and a validation cohort. The pre-treatment scoring model was established based on the clinical and radiological variables using logistic regression and nomogram. The discrimination and calibration of the model were also evaluated.

Results: Logistic regression identified vascularization pattern, ALBI grade, serum alpha-fetoprotein level, serum γ-glutamyl transpeptidase level and major tumor size as the key parameters related to refractoriness. The p-TACE model was established using these variables (risk score range: 0-19.5). Patients were divided into six risk subgroups based on their scores (<4, ≥4, ≥7, ≥10, ≥13, ≥16). The discriminative ability, as determined by the area under receiver operating characteristic curve was 0.784 (95% confidence interval: 0.741-0.827) in the training cohort and 0.743 (95% confidence interval: 0.696-0.789) in the validation cohort. Moreover, satisfactory calibration was confirmed by Hosmer-Lemeshow test with P values of 0.767 and 0.913 in the training cohort and validation cohort.

Conclusions: This study presents a pre-treatment model to identify patients with high risks of refractoriness after transarterial chemoembolization and shed light on clinical decision making.

Keywords: Hepatocellular carcinoma, Transarterial chemoembolization, Refractoriness, Risk stratification


Citation styles

APA
Hu, K., Lu, S., Li, M., Zhang, F., Tang, B., Yuan, J., Shan, Y., Xu, P., Chen, R., Ren, Z., Yin, X. (2020). A Novel Pre-treatment Model Predicting Risk of Developing Refractoriness to Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma. Journal of Cancer, 11(15), 4589-4596. https://doi.org/10.7150/jca.44847.

ACS
Hu, K.; Lu, S.; Li, M.; Zhang, F.; Tang, B.; Yuan, J.; Shan, Y.; Xu, P.; Chen, R.; Ren, Z.; Yin, X. A Novel Pre-treatment Model Predicting Risk of Developing Refractoriness to Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma. J. Cancer 2020, 11 (15), 4589-4596. DOI: 10.7150/jca.44847.

NLM
Hu K, Lu S, Li M, Zhang F, Tang B, Yuan J, Shan Y, Xu P, Chen R, Ren Z, Yin X. A Novel Pre-treatment Model Predicting Risk of Developing Refractoriness to Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma. J Cancer 2020; 11(15):4589-4596. doi:10.7150/jca.44847. https://www.jcancer.org/v11p4589.htm

CSE
Hu K, Lu S, Li M, Zhang F, Tang B, Yuan J, Shan Y, Xu P, Chen R, Ren Z, Yin X. 2020. A Novel Pre-treatment Model Predicting Risk of Developing Refractoriness to Transarterial Chemoembolization in Unresectable Hepatocellular Carcinoma. J Cancer. 11(15):4589-4596.

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