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

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.

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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. Available from http://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