Maehringer-Kunz, Aline, Weinmann, Arndt ORCID: 0000-0003-1198-1716, Schmidtmann, Irene, Koch, Sandra, Schotten, Sebastian, dos Santos, Daniel Pinto, Pitton, Michael Bernhard, Dueber, Christoph, Galle, Peter Robert and Kloeckner, Roman ORCID: 0000-0001-5492-4792 (2018). Validation of the SNACOR clinical scoring system after transarterial chemoembolisation in patients with hepatocellular carcinoma. BMC Cancer, 18. LONDON: BIOMED CENTRAL LTD. ISSN 1471-2407

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Abstract

Background: Transarterial chemoembolisation is the standard of care for intermediate stage (BCLC B) hepatocellular carcinoma, but it is challenging to decide when to repeat or stop treatment. Here we performed the first external validation of the SNACOR (tumour Size and Number, baseline Alpha-fetoprotein, Child-Pugh and Objective radiological Response) risk prediction model. Methods: A total of 1030 patients with hepatocellular carcinoma underwent transarterial chemoembolisation at our tertiary referral centre from January 2000 to December 2016. We determined the following variables that were needed to calculate the SNACOR at baseline: tumour size and number, alpha-fetoprotein level, Child-Pugh class, and objective radiological response after the first transarterial chemoembolisation. Overall survival, timedependent area under receiver-operating characteristic curves, Harrell's C-index, and the integrated Brier score were calculated to assess predictive ability. Finally, multivariate analysis was performed to identify independent predictors of survival. Results: The study included 268 patients. Low, intermediate, and high SNACOR scores predicted a median survival of 31.5, 19.9, and 9.2 months, respectively. The areas under the receiver-operating characteristic curve for overall survival were 0.641, 0.633, and 0.609 at 1, 3, and 6 years, respectively. Harrell's C-index was 0.59, and the integrated Brier Score was 0.175. Independent predictors of survival included tumour size (P < 0.001), baseline alpha-fetoprotein level (P < 0.001) and Child-Pugh class (P < 0.004). Objective radiological response (P = 0.821) and tumour number (P = 0.127) were not additional independent predictors of survival. Conclusions: The SNACOR risk prediction model can be used to identify patients with a dismal prognosis after the first transarterial chemoembolisation who are unlikely to benefit from further transarterial chemoembolisation. However, Harrell's C-index showed only moderate performance. Accordingly, this risk prediction model can only serve as one of several components used to make the decision about whether to repeat treatment.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Maehringer-Kunz, AlineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Weinmann, ArndtUNSPECIFIEDorcid.org/0000-0003-1198-1716UNSPECIFIED
Schmidtmann, IreneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Koch, SandraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Schotten, SebastianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
dos Santos, Daniel PintoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pitton, Michael BernhardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Dueber, ChristophUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Galle, Peter RobertUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Kloeckner, RomanUNSPECIFIEDorcid.org/0000-0001-5492-4792UNSPECIFIED
URN: urn:nbn:de:hbz:38-189014
DOI: 10.1186/s12885-018-4407-5
Journal or Publication Title: BMC Cancer
Volume: 18
Date: 2018
Publisher: BIOMED CENTRAL LTD
Place of Publication: LONDON
ISSN: 1471-2407
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ARTERIAL CHEMOEMBOLIZATION; ALPHA-FETOPROTEIN; SURVIVAL ANALYSIS; PREDICTION ERROR; ART SCORE; RETREATMENT; OUTCOMES; CANCER; PROGNOSIS; MRECISTMultiple languages
OncologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/18901

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