title: TRIP: a pathological score for transarterial chemoembolization resistance individualized prediction in hepatocellular carcinoma.
abstract: OBJECTIVE
  Although potentially very useful in optimizing patient selection and follow-up, the individual response to transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) is generally unpredictable. The aim of this study was to identify tissue predictors of tumour resistance to TACE for use in clinical practice on pretreatment biopsies.
  
  
  METHODS
  We investigated the association of residual tumour in post-TACE-resected HCC with pathological and immunophenotypical features, mainly related to hypoxia and angiogenesis. Comparison of tumour phenotype between post-TACE HCC and both paired pre-TACE biopsies and control TACE-untreated HCC was performed. Cases showing >50% residual tumour (RT) were defined as TACE-resistant.
  
  
  RESULTS
  A consecutive series of 108 HCC from 41 patients was studied. Overall, 45/108 (44%) HCC were classified as TACE-resistant. Among these, 32 (71%) and 40 (89%) showed diffuse CD34 vascular staining and negative VEGF staining respectively (p<0.05). The association of these two parameters in a weighted score (TRIP) was able to predict TACE resistance with 81% accuracy, 89% sensitivity and 59% specificity. The effectiveness of TRIP was validated in an independent series of 28 HCC biopsies from patients subsequently treated with TACE and for whom radiological follow-up was available.
  
  
  CONCLUSIONS
  This study demonstrates the potential value of pretreatment tumour biopsy as predictors of TACE resistance in HCC.
authors: Pathology Department, Humanitas clinical and Research Center and University of Milan School of Medicine, Milan, Italy.
authors: Amedeo
authors: A
authors: Sciarra
authors: Radiology Department, Beaujon Hospital, Clichy, 92110, France.
authors: Maxime
authors: M
authors: Ronot
authors: Pathology Department, Humanitas clinical and Research Center and University of Milan School of Medicine, Milan, Italy.
authors: Luca
authors: L
authors: Di Tommaso
authors: Pathology Department, Humanitas clinical and Research Center and University of Milan School of Medicine, Milan, Italy.
authors: Carlotta
authors: C
authors: Raschioni
authors: Hepatology Department, Beaujon Hospital, Clichy, 92110, France.
authors: Laurent
authors: L
authors: Castera
authors: Liver Surgery and Transplantation Department, Beaujon Hospital, Clichy, 92110, France.
authors: Jacques
authors: J
authors: Belghiti
authors: Pathology Department, Beaujon Hospital, Clichy, 92110, France.
authors: Pierre
authors: P
authors: Bedossa
authors: Radiology Department, Beaujon Hospital, Clichy, 92110, France.
authors: Valérie
authors: V
authors: Vilgrain
authors: Pathology Department, Humanitas clinical and Research Center and University of Milan School of Medicine, Milan, Italy.
authors: Massimo
authors: M
authors: Roncalli
authors: Pathology Department, Beaujon Hospital, Clichy, 92110, France.
authors: Valérie
authors: V
authors: Paradis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin
keywords: Hepatocellular carcinoma; biopsy; predictive response; transarterial chemoembolization