title: A Modified Model for Assessment for Retreatment with Transarterial Chemoembolization in Chinese Hepatocellular Carcinoma Patients.
abstract: OBJECTIVE
  To develop a modified assessment for retreatment with transarterial chemoembolization (mART) score that may be more suitable for Chinese patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  Chinese patients with HCC who were treated with transarterial chemoembolization in four hospitals were included. A univariate analysis and a multivariate forward Cox regression analysis were used to identify significant prognostic factors of overall survival (OS). A point scoring model was subsequently developed from the training cohort, and the validation process was performed in the validation cohort.
  
  
  RESULTS
  The study included 259 patients (124 patients in the training cohort and 135 patients in the validation cohort). Increase in Child-Pugh scores relative to the baseline (P < .001), Barcelona Clinic Liver Cancer (BCLC) stage B before first transarterial chemoembolization (P = .001), and absence of radiologic tumor response (P < .001) were identified as negative prognostic factors for OS and were used to create the mART scores. BCLC staging was substituted for aspartate aminotransferase increase in the mART scores. The mART scores differentiated two groups with distinct prognosis by a cutoff score of 2.5 points (22.9 mo [95% confidence interval (CI), 17.4-28.4] vs 8.9 mo [95% CI, 7.5-10.3] in median survival; P < .001). In the validation cohort, the C index in assessment for retreatment with transarterial chemoembolization (ART) criteria was 0.64, whereas it was 0.82 in mART criteria.
  
  
  CONCLUSIONS
  In Chinese patients with HCC, mART score of > 2.5 before second transarterial chemoembolization was associated with poor prognosis. The mART score was probably better validated compared with the ART score.
authors.affiliation: Department of Radiology, Zhong-da Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China.
authors.forename: Li
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Interventional Radiology, First Affiliated Hospital of Soochow University, Suzhou, China.
authors.forename: Cai-Fang
authors.initials: CF
authors.lastname: Ni
authors.affiliation: Department of Interventional Radiology, Cancer Hospital of Jiangsu Province, Cancer Institution of Jiangsu Province, Nanjing, China.
authors.forename: Shi-Xi
authors.initials: SX
authors.lastname: Chen
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, China.
authors.forename: Jian-Min
authors.initials: JM
authors.lastname: Cao
authors.affiliation: Department of Radiology, Zhong-da Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China.
authors.forename: Hai-Dong
authors.initials: HD
authors.lastname: Zhu
authors.affiliation: Department of Radiology, Zhong-da Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China.
authors.forename: Jin-He
authors.initials: JH
authors.lastname: Guo
authors.affiliation: Department of Radiology, Zhong-da Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China.
authors.forename: Guang-Yu
authors.initials: GY
authors.lastname: Zhu
authors.affiliation: Department of Radiology, Zhong-da Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China.
authors.forename: Bin-Yan
authors.initials: BY
authors.lastname: Zhong
authors.affiliation: Department of Radiology, Zhong-da Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Ding
authors.affiliation: Department of Radiology, Zhong-da Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China.
authors.forename: Shi-Cheng
authors.initials: SC
authors.lastname: He
authors.affiliation: Department of Radiology, Zhong-da Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Deng
authors.affiliation: Department of Radiology, Zhong-da Hospital, Medical School, Southeast University, 87 Dingjiaqiao Road, Nanjing 210009, China. Electronic address: gjteng@vip.sina.com.
authors.forename: Gao-Jun
authors.initials: GJ
authors.lastname: Teng
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002681:China; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome