title: Retreatment with TACE: the ABCR SCORE, an aid to the decision-making process.
abstract: OBJECTIVE
  Transarterial chemoembolization (TACE) is the standard of care for intermediate stage hepatocellular carcinoma (HCC) and it is the most commonly used treatment for HCC worldwide. However, no prognostic indices, designed to select appropriate candidates for repeat conventional TACE, have been incorporated in the guidelines.
  
  
  METHODS
  From January 2007 to April 2012, 139 consecutive HCC patients, mainly with an alcohol- or viral-induced disease, were treated with TACE. Using a regression model on the prognostic variables of our population, we determined a score designed to help for repeat TACE and we validated it in two cohorts. We also compared it to the ART score.
  
  
  RESULTS
  In the multivariate analysis, four prognostic factors were associated with overall survival: BCLC and AFP (>200 ng/ml) at baseline, increase in Child-Pugh score by ⩾2 from baseline, and absence of radiological response. These factors were included in a score (ABCR, ranging from -3 to +6), which correlates with survival and identifies three groups. The ABCR score was validated in two different cohorts of 178 patients and proofed to perform better than the ART score in distinguishing between patients' prognosis.
  
  
  CONCLUSIONS
  The ABCR score is a simple and clinically relevant index, summing four prognostic variables endorsed in HCC. An ABCR score ⩾4 prior to the second TACE identifies patients with dismal prognosis who may not benefit from further TACE sessions.
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Saint-Joseph Marseille, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Adhoute
authors.affiliation: AlphaBio Laboratory Marseille, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Penaranda
authors.affiliation: Department of Hepato-Gastroenterology, Centre Hospitalier Universitaire de Nancy, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Naude
authors.affiliation: Department of Hepato-Gastroenterology and Digestive Oncology, Institut Paoli Calmette Marseille, France.
authors.forename: Jean Luc
authors.initials: JL
authors.lastname: Raoul
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Saint-Joseph Marseille, France.
authors.forename: Herve
authors.initials: H
authors.lastname: Perrier
authors.affiliation: Department of Radiology, Hôpital Saint-Joseph Marseille, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Bayle
authors.affiliation: Department of Radiology, Hôpital Saint-Joseph Marseille, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Monnet
authors.affiliation: Department of Radiology, Hôpital Saint-Joseph Marseille, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Beaurain
authors.affiliation: Department of Radiology, Centre Hospitalier Universitaire de Nancy, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Bazin
authors.affiliation: Department of Surgery, Hôpital Saint-Joseph Marseille, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Pol
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Saint-Joseph Marseille, France.
authors.forename: Gaelle Le
authors.initials: GL
authors.lastname: Folgoc
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Saint-Joseph Marseille, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Castellani
authors.affiliation: INSERM U954, Université de Lorraine, CHU de Nancy, Vandoeuvre les Nancy, France; Department of Hepato-Gastroenterology, Centre Hospitalier Universitaire de Nancy, France.
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Bronowicki
authors.affiliation: Department of Hepato-Gastroenterology, Hôpital Saint-Joseph Marseille, France. Electronic address: mbourliere@hopital-saint-joseph.fr.
authors.forename: Marc
authors.initials: M
authors.lastname: Bourlière
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy; D016461:Chemoembolization, Therapeutic / Q000379:methods / Q000706:statistics & numerical data; D003661:Decision Support Techniques; D005260:Female; D005602:France; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D057216:Propensity Score; D019233:Retreatment / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies
keywords: ABCR score; ART score; BCLC; Chemoembolization; HCC; Radiological response; TACE