PMID- 35260337 OWN - NLM STAT- MEDLINE DCOM- 20231003 LR - 20231003 IS - 1499-3872 (Print) VI - 22 IP - 5 DP - 2023 Oct TI - ASARA, a prediction model based on Child-Pugh class in hepatocellular carcinoma patients undergoing transarterial chemoembolization. PG - 490-497 LID - S1499-3872(22)00015-7 [pii] LID - 10.1016/j.hbpd.2022.02.007 [doi] AB - BACKGROUND: Due to the high heterogeneity among hepatocellular carcinoma (HCC) patients receiving transarterial chemoembolization (TACE), the prognosis of patients varies significantly. The decision-making on the initiation and/or repetition of TACE under different liver functions is a matter of concern in clinical practice. Thus, we aimed to develop a prediction model for TACE candidates using risk stratification based on varied liver function. METHODS: A total of 222 unresectable HCC patients who underwent TACE as their only treatment were included in this study. Cox proportional hazards regression was performed to select the independent risk factors and establish a predictive model for the overall survival (OS). The model was validated in patients with different Child-Pugh class and compared to previous TACE scoring systems. RESULTS: The five independent risk factors, including alpha-fetoprotein (AFP) level, maximal tumor size, the increase of albumin-bilirubin (ALBI) grade score, tumor response, and the increase of aspartate aminotransferase (AST), were used to build a prognostic model (ASARA). In the training and validation cohorts, the OS of patients with ASARA score 2 (P < 0.001, P = 0.006, respectively). The ASARA model and its modified version "AS(ARA)" can effectively distinguish the OS (P < 0.001, P = 0.004) between patients with Child-Pugh class A and B, and the C-index was 0.687 and 0.706, respectively. For repeated TACE, the ASARA model was superior to Assessment for Retreatment with TACE (ART) and ALBI grade, maximal tumor size, AFP, and tumor response (ASAR) among Child-Pugh class A patients. For the first TACE, the performance of AS(ARA) was better than that of modified hepatoma arterial-embolization prognostic (mHAP), mHAP3, and ASA(R) models among Child-Pugh class B patients. CONCLUSIONS: The ASARA scoring system is valuable in the decision-making of TACE repetition for HCC patients, especially Child-Pugh class A patients. The modified AS(ARA) can be used to screen the ideal candidate for TACE initiation in Child-Pugh class B patients with poor liver function. CI - Copyright (c) 2022 First Affiliated Hospital, Zhejiang University School of Medicine in China. Published by Elsevier B.V. All rights reserved. FAU - Jia, Ke-Feng AU - Jia KF AD - Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin 300192, China; Department of Radiology, Tianjin Third Central Hospital, Tianjin 300170, China. FAU - Wang, Hao AU - Wang H AD - Department of Radiology, First Central Clinical College, Tianjin Medical University, Tianjin 300192, China; Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China. FAU - Yu, Chang-Lu AU - Yu CL AD - Department of Radiology, Tianjin Third Central Hospital, Tianjin 300170, China. FAU - Yin, Wei-Li AU - Yin WL AD - Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital, Tianjin 300170, China. FAU - Zhang, Xiao-Dong AU - Zhang XD AD - Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China. FAU - Wang, Fang AU - Wang F AD - Department of Gastroenterology and Hepatology, Tianjin Third Central Hospital, Tianjin 300170, China. FAU - Sun, Cheng AU - Sun C AD - Department of Radiology, Tianjin Third Central Hospital, Tianjin 300170, China. FAU - Shen, Wen AU - Shen W AD - Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China. Electronic address: shenwen66happy@126.com. LA - eng PT - Journal Article DEP - 20220225 PL - Singapore TA - Hepatobiliary Pancreat Dis Int JT - Hepatobiliary & pancreatic diseases international : HBPD INT JID - 101151457 RN - 0 (alpha-Fetoproteins) RN - RFM9X3LJ49 (Bilirubin) SB - IM MH - Humans MH - *Carcinoma, Hepatocellular/pathology MH - *Liver Neoplasms/pathology MH - alpha-Fetoproteins MH - *Chemoembolization, Therapeutic/adverse effects MH - Prognosis MH - Bilirubin MH - Retrospective Studies OTO - NOTNLM OT - Child-Pugh class OT - Hepatocellular carcinoma OT - Prognostic model OT - Scoring system OT - Survival prediction OT - Transarterial chemoembolization EDAT- 2022/03/10 06:00 MHDA- 2023/10/03 06:46 CRDT- 2022/03/09 05:33 PHST- 2021/05/26 00:00 [received] PHST- 2022/02/21 00:00 [accepted] PHST- 2023/10/03 06:46 [medline] PHST- 2022/03/10 06:00 [pubmed] PHST- 2022/03/09 05:33 [entrez] AID - S1499-3872(22)00015-7 [pii] AID - 10.1016/j.hbpd.2022.02.007 [doi] PST - ppublish SO - Hepatobiliary Pancreat Dis Int. 2023 Oct;22(5):490-497. doi: 10.1016/j.hbpd.2022.02.007. Epub 2022 Feb 25.