title: Combined sequential use of HAP and ART scores to predict survival outcome and treatment failure following chemoembolization in hepatocellular carcinoma: a multi-center comparative study.
abstract: BACKGROUND
  The prognosis of patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE) is variable, despite a myriad of prognostic markers. We compared and integrated the established prognostic models, HAP and ART scores, for their accuracy of overall survival (OS) prediction.
  
  
  RESULTS
  In both training and validation sets, HAP and ART scores emerged as independent predictors of OS (p<0.01) with HAP achieving better prognostic accuracy (c-index: 0.68) over ART (0.57). We tested both scores in combination to evaluate their combined ability to predict OS. Subgroup analysis of BCLC-C patients revealed favorable HAP stage (p<0.001) and radiological response after initial TACE (p<0.001) as positive prognostic factors.
  
  
  METHODS
  Prognostic scores were studied using multivariable Cox regression and c-index analysis in 83 subjects with Barcelona Clinic Liver Cancer (BCLC) A/B stage from UK and Italy (training set), and 660 from Korea and Japan (validation set), all treated with conventional TACE. Scores were further validated in an separate analysis of patients with BCLC-C stage disease (n=63) receiving initial TACE.
  
  
  CONCLUSIONS
  ART and HAP scores are validated indices in patients with intermediate stage HCC undergoing TACE. The HAP score is best suited for screening patients prior to initial TACE, whilst sequential ART assessment improves early detection of chemoembolization failure. BCLC-C patients with low HAP stage may be a subgroup where TACE should be explored in clinical studies.
authors.affiliation: Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Pinato
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan.
authors.forename: Tadaaki
authors.initials: T
authors.lastname: Arizumi
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea Incheon St. Mary's Hospital, Seoul, Republic of Korea.
authors.forename: Jeong Won
authors.initials: JW
authors.lastname: Jang
authors.affiliation: Department of Translational Medicine, Università degli Studi del Piemonte Orientale "A. Avogadro", Novara, Italy.|School of Public Health, Università degli Studi di Torino, Torino, Italy.
authors.forename: Elias
authors.initials: E
authors.lastname: Allara
authors.affiliation: Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK.
authors.forename: Puvan I
authors.initials: PI
authors.lastname: Suppiah
authors.affiliation: Department of Translational Medicine, Università degli Studi del Piemonte Orientale "A. Avogadro", Novara, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Smirne
authors.affiliation: Department of Radiology, Imperial College NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Tait
authors.affiliation: Department of Surgery, Imperial College NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: Madhava
authors.initials: M
authors.lastname: Pai
authors.affiliation: Department of Translational Medicine, Università degli Studi del Piemonte Orientale "A. Avogadro", Novara, Italy.
authors.forename: Glenda
authors.initials: G
authors.lastname: Grossi
authors.affiliation: Department of Internal Medicine, The Catholic University of Korea Incheon St. Mary's Hospital, Seoul, Republic of Korea.
authors.forename: Young Woon
authors.initials: YW
authors.lastname: Kim
authors.affiliation: Department of Translational Medicine, Università degli Studi del Piemonte Orientale "A. Avogadro", Novara, Italy.|Interdisciplinary Research Center of Autoimmune Diseases, Università degli Studi del Piemonte Orientale "A. Avogadro", Novara, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Pirisi
authors.affiliation: Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kudo
authors.affiliation: Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, UK.
authors.forename: Rohini
authors.initials: R
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007558:Italy; D007564:Japan; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D011379:Prognosis; D016016:Proportional Hazards Models; D056910:Republic of Korea; D016019:Survival Analysis; D017211:Treatment Failure; D006113:United Kingdom
keywords: ART score; HAP score; TACE; hepatocellular carcinoma; prognosis