Title:Development and Validation of a Risk Prediction Algorithm for
Evaluating the Efficacy of Postoperative Adjuvant TACE Therapy for
Hepatocellular Carcinoma
Volume: 27
Issue: 8
Author(s): Jie Tao, Xiaoli Shi, Xu Feng, Xinhua Wu, Shiguai Qi, Guoying Feng, Xu Yang, Yufei Zhao, Hangjia Zuo and Zhengrong Shi*
Affiliation:
- Department of General Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016,
China
Keywords:
TACE, neutrophil-lymphocyte ratio, edmondson-steiner, hepatocellular carcinoma, postoperative adjuvant TACE therapy, prediction model.
Abstract:
Background and Purpose: There is a lack of a reliable outcome prediction model for
patients evaluating the feasibility of postoperative adjuvant transarterial chemoembolization (PATACE)
therapy. Our goal was to develop an easy-to-use tool specifically for these patients.
Methods: From January 2013 to June 2017, patients with hepatocellular carcinoma from the Liver
Center of the First Affiliated Hospital of Chongqing Medical University received postoperative adjuvant
Transarterial chemoembolization (TACE) therapy after liver cancer resection. A Cox proportional
hazards model was established for these patients, followed by internal validation (enhanced
bootstrap resampling technique) to further evaluate the predictive performance and discriminanceevaluate
the predictive performance and discriminance, and compare it with other predictive
models. The prognostic factors considered included tumour number, maximum tumor diameter,
Edmondson-Steiner (ES) grade, Microvascular invasion (MVI) grade, Ki67, age, sex, hepatitis
B surface antigen, cirrhosis, Alpha-fetoprotein (AFP), Albumin-bilirubin (ALBI) grade, Childpugh
grade, body mass index (BMI), Neutrophil-lymphocyte ratio (NLR), Platelet-to-lymphocyte
ratio (PLR).
Results: The endpoint of the study was overall survival. The median overall survival was 36
(95%CI: 34.0-38.0) months, with 1-year, 2-year and 3-year survival rates being 96.3%, 84.0% and
75.3%, respectively. Tumour number, MVI grade, and BMI was incorporated into the model,
which had good differentiation and accuracy. Internal validation (enhanced bootstrap) suggested
that Harrell’s C statistic is 0.72. The model consistently outperforms other currently available
models.
Conclusion: This model may be an easy-to-use tool for screening patients suitable for PA-TACE
treatment and guiding the selection of clinical protocols. But further research and external validation
are required.