Tesi di specializzazione (5 anni)
Scoring system in intermediate-stage HCC treated with TACE.
RICERCA TRASLAZIONALE E DELLE NUOVE TECNOLOGIE IN MEDICINA E CHIRURGIA
Corso di studi
relatore Prof. Bartolozzi, Carlo
Data inizio appello
Data di rilascio
PURPOSE: To identify predictors of overall survival (OS) in naïve intermediate-stage HCC patients undergoing transarterial chemoembolization (TACE) and to suggest an objective point score for patients’ stratification.<br>MATERIALS AND METHODS: We retrospectively reviewed clinical and demographic data of 149 patients (125 males; mean age 65 years) with naïve intermediate-stage HCC treated with TACE between 2006 and 2011. Tumor response at 1 month was defined according to mRECIST. Stepwise Cox regression model was used to identify predictors of OS and develop an objective point score. <br>RESULTS: Median OS was 22.7 months. At multivariate analysis, negative independent prognostic factors for OS were age >65 years (HR 1.80; P=.0048), ascites (HR 2.36; P=.0041) and progressive disease after TACE (HR 4.68; P<.0001), while positive independent prognostic factors were maximum total HCC diameter according to mRECIST ≤ 60 mm (HR: 0.49; P=.0015) and complete response after TACE (HR 0.64; P=.048). A 5-point scale pre-procedural and an 8-point scale pre- and post-procedural score were created, and for each one three group of patients were identified. Regarding pre-TACE score, patients with score <0 had a significantly longer OS (40.2 months, group A) compared to patients with score=0 (27 months, group B) and score >0 (15.3 months, group C). When considering pre and post-procedural variables, group post-A had median OS of 40.2 months, significantly longer than groups post-B (scores 0-1, median OS 21.1 months) and post-C (score ≥2, median OS of 8.3 months).<br>CONCLUSIONS: Combining pre- and post-TACE parameters, our scoring system enables a simple stratification of intermediate-stage HCC patients. <br>
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