title: Transarterial chemo-embolisation of hepatocellular carcinoma: impact of liver function and vascular invasion.
abstract: BACKGROUND
  Transarterial chemo-embolisation (TACE) is recommended for patients with BCLC intermediate stage hepatocellular carcinoma (stage B), particularly in patients with good underlying liver function and minimal symptoms. The hepatoma arterial embolisation prognostic (HAP) score combines measures of liver function and tumour-related factors to offer a simple prognostic scoring system. The Albumin-Bilirubin (ALBI) grade permits assessment of the impact of liver function on survival. We aimed to investigate these two models and vascular invasion (VI).
  
  
  METHODS
  In an international cohort of 3030 patients undergoing TACE, we examined the impact of liver function as assessed by the ALBI score, the HAP score and VI on survival.
  
  
  RESULTS
  Classification according to ALBI grade resulted in non-overlapping survival curves in the overall data set and all regional cohorts. The HAP score was also validated. Tumour number, aetiology and VI were identified as additional independent prognostic risk factors not currently included in the HAP score. Survival was particularly poor for patients with VI.
  
  
  CONCLUSIONS
  The ALBI grade categorised patients receiving TACE into three clear prognostic groups, thereby emphasising the importance of underlying liver function in the outcome of TACE. The HAP score has been validated internationally and the serious adverse impact of VI is clearly shown.
authors.affiliation: Department of Hepatology, National Liver Institute, Menoufeya University, Menoufia Governorate, Egypt.
authors.forename: Imam
authors.initials: I
authors.lastname: Waked
authors.affiliation: Department of Molecular and Clinical Cancer Medicine, University of Liverpool, The Sherrington Building, Ashton Street, Liverpool L69 3GA, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Berhane
authors.affiliation: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu 503-8052, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Toyoda
authors.affiliation: Department of Anatomical & Cellular Pathology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Chan
authors.affiliation: Digestive Diseases Unit, Aintree University Hospitals NHS Foundation Trust, University Hospital Aintree, Liverpool, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Stern
authors.affiliation: Department of Molecular and Clinical Cancer Medicine, University of Liverpool, The Sherrington Building, Ashton Street, Liverpool L69 3GA, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Palmer
authors.affiliation: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu 503-8052, Japan.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Tada
authors.affiliation: State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China.
authors.forename: Winnie
authors.initials: W
authors.lastname: Yeo
authors.affiliation: State Key Laboratory in Oncology in South China, Sir Y. K. Pao Centre for Cancer, Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong Cancer Institute, Hong Kong, China.
authors.forename: Frankie
authors.initials: F
authors.lastname: Mo
authors.affiliation: Department of Internal Medicine II, University Hospital Freiburg, Hugstetter Street 55, Freiburg D-79106, Germany.
authors.forename: Dominik
authors.initials: D
authors.lastname: Bettinger
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Carl Neuberg Street 1, Hannover 30625, Germany.
authors.forename: Martha M
authors.initials: MM
authors.lastname: Kirstein
authors.affiliation: Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra; and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Pamplona, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Iñarrairaegui
authors.affiliation: Department of Hepatology, National Liver Institute, Menoufeya University, Menoufia Governorate, Egypt.
authors.forename: Asmaa
authors.initials: A
authors.lastname: Gomaa
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Carl Neuberg Street 1, Hannover 30625, Germany.
authors.forename: Arndt
authors.initials: A
authors.lastname: Vogel
authors.affiliation: Department of Oncology, UCL Cancer Institute, University College London, London, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Meyer
authors.affiliation: Liver Unit and HPB Oncology Area, Clinica Universidad de Navarra; and Centro de Investigacion Biomedica en Red de Enfermedades Hepaticas y Digestivas (CIBEREHD), Pamplona, Spain.
authors.forename: Bruno
authors.initials: B
authors.lastname: Sangro
authors.affiliation: Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Paul
authors.initials: P
authors.lastname: Lai
authors.affiliation: Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Gifu 503-8052, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kumada
authors.affiliation: Department of Molecular and Clinical Cancer Medicine, University of Liverpool, The Sherrington Building, Ashton Street, Liverpool L69 3GA, UK.|The Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington, Wirral CH63 4JY, UK.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Johnson
mesh_terms: D000368:Aged; D001663:Bilirubin / Q000097:blood / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000473:pathology / Q000503:physiopathology*; D008113:Liver Neoplasms / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D015203:Reproducibility of Results; D012107:Research Design; D012709:Serum Albumin / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D012709:Serum Albumin; D001663:Bilirubin