title: The CRP level and STATE score predict survival in cirrhotic patients with hepatocellular carcinoma treated by transarterial embolization.
abstract: BACKGROUND
  Prognostic biomarkers are needed in a heterogeneous population of patients with intermediate hepatocellular carcinoma (HCC) treated by transarterial (chemo)embolization. We aimed to validate the prognostic value of serum CRP levels and the STATE score, combining CRP, albumin and tumor burden.
  
  
  METHODS
  All cirrhotic patients with HCC treated by a first transarterial (chemo)embolization (2007-2013) in our institution were included. Overall survival was assessed using the Kaplan-Meier method, log rank, univariate and multivariate Cox analyses.
  
  
  RESULTS
  Among 157 patients included, 87% were men, 86% had Child Pugh A. Etiologies of liver disease included alcohol (57%), hepatitis C (32%), hepatitis B (11%) and/or metabolic syndrome (32%); 89% of patients were classified BCLC B. 33% of the patients had a CRP >1mg/dl and 33% a STATE score conferring poor prognosis (<18). Patients with CRP <1mg/dl had better overall survival than patients with CRP >1mg/dl (20 vs. 8 months, P=0.00186). Median overall survival was 6.73 months for patients with a STATE score <18 vs. 22.23 months for patients with STATE-score ≥18 (P=0.0002). In multivariate analysis, a STATE score <18 was independently associated with increased mortality (HR: 2.06 (CI95%: 1.28-3.34), P=0.0031).
  
  
  CONCLUSIONS
  In cirrhotic patients with HCC who underwent transarterial treatment, serum CRP level and STATE score at baseline can predict overall survival.
authors.affiliation: APHP, Hôpitaux universitaires Paris - Seine Saint-Denis, Jean Verdier, Liver Unit, Bondy, France.
authors.forename: Samia
authors.initials: S
authors.lastname: Rekik
authors.affiliation: APHP, Hôpitaux universitaires Paris - Seine Saint-Denis, Jean Verdier, Biochemistry Department, Bondy, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Guyot
authors.affiliation: APHP, Hôpitaux universitaires Paris - Seine Saint-Denis, Jean Verdier, Liver Unit, Bondy, France.
authors.forename: Mohannad
authors.initials: M
authors.lastname: Bhais
authors.affiliation: APHP, Hôpitaux universitaires Paris - Seine Saint-Denis, Jean Verdier, Radiology Department, Bondy, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Ajavon
authors.affiliation: APHP, Hôpitaux universitaires Paris - Seine Saint-Denis, Jean Verdier, Liver Unit, Bondy, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Grando
authors.affiliation: APHP, Hôpitaux universitaires Paris - Seine Saint-Denis, Jean Verdier, Liver Unit, Bondy, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Bourcier
authors.affiliation: APHP, Hôpitaux universitaires Paris - Seine Saint-Denis, Jean Verdier, Liver Unit, Bondy, France.
authors.forename: Gisèle
authors.initials: G
authors.lastname: Nkontchou
authors.affiliation: APHP, Hôpitaux universitaires Paris - Seine Saint-Denis, Jean Verdier, Liver Unit, Bondy, France; Inserm, UMR-1162, Functional Genomic of Solid Tumors, Team "Ligue Contre le Cancer", Paris, France; Paris Descartes University, Labex Immuno-Oncology, Sorbonne Paris Cité, Paris, France; Paris 13 University, Sorbonne Paris Cité, UFR SMBH, Bobigny, France; Paris Diderot University, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Nahon
authors.affiliation: APHP, Hôpitaux universitaires Paris - Seine Saint-Denis, Jean Verdier, Radiology Department, Bondy, France; Paris 13 University, Sorbonne Paris Cité, UFR SMBH, Bobigny, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sellier
authors.affiliation: APHP, Hôpitaux universitaires Paris - Seine Saint-Denis, Jean Verdier, Radiology Department, Bondy, France; Inserm, UMR-1162, Functional Genomic of Solid Tumors, Team "Ligue Contre le Cancer", Paris, France; Paris Descartes University, Labex Immuno-Oncology, Sorbonne Paris Cité, Paris, France; Paris 13 University, Sorbonne Paris Cité, UFR SMBH, Bobigny, France; Paris Diderot University, Paris, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Seror
authors.affiliation: APHP, Hôpitaux universitaires Paris - Seine Saint-Denis, Jean Verdier, Liver Unit, Bondy, France; Inserm, UMR-1162, Functional Genomic of Solid Tumors, Team "Ligue Contre le Cancer", Paris, France; Paris Descartes University, Labex Immuno-Oncology, Sorbonne Paris Cité, Paris, France; Paris 13 University, Sorbonne Paris Cité, UFR SMBH, Bobigny, France; Paris Diderot University, Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Ganne-Carrie
authors.affiliation: APHP, Hôpitaux universitaires Paris - Seine Saint-Denis, Jean Verdier, Liver Unit, Bondy, France; Inserm, UMR-1162, Functional Genomic of Solid Tumors, Team "Ligue Contre le Cancer", Paris, France; Paris Descartes University, Labex Immuno-Oncology, Sorbonne Paris Cité, Paris, France; Paris 13 University, Sorbonne Paris Cité, UFR SMBH, Bobigny, France; Paris Diderot University, Paris, France. Electronic address: naultjc@gmail.com.
authors.forename: Jean-Charles
authors.initials: JC
authors.lastname: Nault
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis*; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D005260:Female; D005602:France; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis*; D012720:Severity of Illness Index; D047368:Tumor Burden
chemical_list: D014408:Biomarkers, Tumor; D012709:Serum Albumin; D002097:C-Reactive Protein
keywords: CRP; Hepatocellular carcinoma; Inflammation; STATE score; Transarterial chemo-embolization