Advertisement

Prognostic scores for sorafenib-treated hepatocellular carcinoma patients: A new application for the hepatoma arterial embolisation prognostic score

Published:October 04, 2017DOI:https://doi.org/10.1016/j.ejca.2017.08.036

      Highlights

      • We studied a training set of 370 patients treated with sorafenib for HCC.
      • Variables associated with OS were PS, AFP, tumor size, bilirubin and albumin.
      • We designed a new prognostic model and validated it in a cohort of 468 patients.
      • However, the HAP score was the most discriminant model in the validation cohort.
      • The HAP score could be thus used as a prognostic model in this population.

      Abstract

      Background

      No prognostic classification is currently used for patients treated with systemic therapies for Hepatocellular Carcinoma (HCC).

      Methods

      We retrospectively analysed data from patients treated with sorafenib for HCC from five centres in France and in the United Kingdom (UK). The training set comprised data from two centres and the validation set from three. Variables independently associated with Overall Survival (OS) in the training set were used to build the SAP (Sorafenib Advanced HCC Prognosis) score. The score was tested in the validation set, then compared with other prognostication systems.

      Results

      The training set and validation set included 370 and 468 patients respectively. In the training set, variables independently associated with OS in multivariable analysis were: performance status (PS) >0, alpha-fetoprotein (AFP) >400 ng/ml, tumour size >7 cm, bilirubin >17 μmol/l and albumin <36 g/l. The SAP score was built giving one point to each abnormal variable, and three classes were constructed. The SAP score was significantly associated with OS in the training set, with median OS of 14.9 months for SAP A, 7.2 months for SAP B and 2.5 months for SAP C (P < 0.001). In the validation set, the SAP score was significantly associated with OS, and showed greater discriminative abilities than Barcelona Clinic Liver Cancer (BCLC) and albumin-bilirubin (ALBI) scores. However, the hepatoma arterial embolisation prognostic (HAP) score showed greater discriminative abilities than the SAP score.

      Conclusion

      In European patients treated with sorafenib, the HAP was the most discriminant prognostic score and may facilitate stratification in trials and inform clinical decision making.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Torre L.A.
        • Bray F.
        • Siegel R.L.
        • Ferlay J.
        • Lortet-Tieulent J.
        • Jemal A.
        Global cancer statistics, 2012.
        CA Cancer J Clin. 2015; 65: 87-108https://doi.org/10.3322/caac.21262
        • EASL, EORTC
        EASL–EORTC clinical practice guidelines: management of hepatocellular carcinoma.
        J Hepatol. 2012; 56: 908-943
        • Verslype C.
        • Rosmorduc O.
        • Rougier P.
        • ESMO Guidelines Working Group
        Hepatocellular carcinoma: ESMO-ESDO clinical practice guidelines for diagnosis, treatment and follow-up.
        Ann Oncol Off J Eur Soc Med Oncol. 2012; 23: vii41-vii48https://doi.org/10.1093/annonc/mds225
        • Di Marco V.
        • De Vita F.
        • Koskinas J.
        • Semela D.
        • Toniutto P.
        • Verslype C.
        Sorafenib: from literature to clinical practice.
        Ann Oncol Off J Eur Soc Med Oncol. 2013; 24: ii30-ii37https://doi.org/10.1093/annonc/mdt055
        • Bruix J.
        • Qin S.
        • Merle P.
        • Granito A.
        • Huang Y.-H.
        • Bodoky G.
        • et al.
        Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment (RESORCE): a randomised, double-blind, placebo-controlled, phase 3 trial.
        Lancet Lond Engl. 2017; 389: 56-66https://doi.org/10.1016/S0140-6736(16)32453-9
      1. A new prognostic system for hepatocellular carcinoma: a retrospective study of 435 patients: the Cancer of the Liver Italian Program (CLIP) investigators.
        Hepatol Balt Md. 1998; 28: 751-755https://doi.org/10.1002/hep.510280322
        • Okuda K.
        • Obata H.
        • Nakajima Y.
        • Ohtsuki T.
        • Okazaki N.
        • Ohnishi K.
        Prognosis of primary hepatocellular carcinoma.
        Hepatol Balt Md. 1984; 4: 3S-6S
        • Johnson P.J.
        • Berhane S.
        • Kagebayashi C.
        • Satomura S.
        • Teng M.
        • Reeves H.L.
        • et al.
        Assessment of liver function in patients with hepatocellular carcinoma: a new evidence-based approach–the ALBI grade.
        J Clin Oncol. 2015; 33: 550-558https://doi.org/10.1200/JCO.2014.57.9151
        • Yau T.
        • Tang V.Y.F.
        • Yao T.-J.
        • Fan S.-T.
        • Lo C.-M.
        • Poon R.T.P.
        Development of Hong Kong Liver Cancer staging system with treatment stratification for patients with hepatocellular carcinoma.
        Gastroenterology. 2014; 146 (1691–1700.e3)https://doi.org/10.1053/j.gastro.2014.02.032
        • Chevret S.
        • Trinchet J.C.
        • Mathieu D.
        • Rached A.A.
        • Beaugrand M.
        • Chastang C.
        A new prognostic classification for predicting survival in patients with hepatocellular carcinoma. Grouped'Etudeet de Traitement du Carcinome Hépatocellulaire.
        J Hepatol. 1999; 31: 133-141
        • Liu P.-H.
        • Hsu C.-Y.
        • Hsia C.-Y.
        • Lee Y.-H.
        • Su C.-W.
        • Huang Y.-H.
        • et al.
        Prognosis of hepatocellular carcinoma: assessment of eleven staging systems.
        J Hepatol. 2016; 64: 601-608https://doi.org/10.1016/j.jhep.2015.10.029
        • Marrero J.A.
        • Fontana R.J.
        • Barrat A.
        • Askari F.
        • Conjeevaram H.S.
        • Su G.L.
        • et al.
        Prognosis of hepatocellular carcinoma: comparison of 7 staging systems in an American cohort.
        Hepatol Balt Md. 2005; 41: 707-716https://doi.org/10.1002/hep.20636
        • Kadalayil L.
        • Benini R.
        • Pallan L.
        • O'Beirne J.
        • Marelli L.
        • Yu D.
        • et al.
        A simple prognostic scoring system for patients receiving transarterial embolisation for hepatocellular cancer.
        Ann Oncol Off J EurSoc Med Oncol ESMO. 2013; 24: 2565-2570https://doi.org/10.1093/annonc/mdt247
        • Hucke F.
        • Pinter M.
        • Graziadei I.
        • Bota S.
        • Vogel W.
        • Müller C.
        • et al.
        How to STATE suitability and START transarterial chemoembolization in patients with intermediate stage hepatocellular carcinoma.
        J Hepatol. 2014; 61: 1287-1296https://doi.org/10.1016/j.jhep.2014.07.002
        • Hucke F.
        • Sieghart W.
        • Pinter M.
        • Graziadei I.
        • Vogel W.
        • Müller C.
        • et al.
        The ART-strategy: sequential assessment of the ART score predicts outcome of patients with hepatocellular carcinoma re-treated with TACE.
        J Hepatol. 2014; 60: 118-126https://doi.org/10.1016/j.jhep.2013.08.022
        • Adhoute X.
        • Penaranda G.
        • Naude S.
        • Raoul J.L.
        • Perrier H.
        • Bayle O.
        • et al.
        Retreatment with TACE: the ABCR SCORE, an aid to the decision-making process.
        J Hepatol. 2015; 62: 855-862https://doi.org/10.1016/j.jhep.2014.11.014
        • Bolondi L.
        • Burroughs A.
        • Dufour J.-F.
        • Galle P.R.
        • Mazzaferro V.
        • Piscaglia F.
        • et al.
        Heterogeneity of patients with intermediate (BCLC B) hepatocellular carcinoma: proposal for a subclassification to facilitate treatment decisions.
        Semin Liver Dis. 2012; 32: 348-359https://doi.org/10.1055/s-0032-1329906
        • Adhoute X.
        • Pénaranda G.
        • Raoul J.L.
        • Blanc J.F.
        • Edeline J.
        • Conroy G.
        • et al.
        Prognosis of advanced hepatocellular carcinoma: a new stratification of Barcelona Clinic Liver Cancer stage C: results from a French multicenter study.
        Eur J Gastroenterol Hepatol. 2016; 28: 433-440https://doi.org/10.1097/MEG.0000000000000558
        • Choi G.H.
        • Han S.
        • Shim J.H.
        • Ryu M.-H.
        • Ryoo B.-Y.
        • Kang Y.-K.
        • et al.
        Prognostic scoring models for patients undergoing sorafenib treatment for advanced stage hepatocellular carcinoma in real-life practice.
        Am J Clin Oncol. 2014; : 1https://doi.org/10.1097/COC.0000000000000132
        • Takeda H.
        • Nishikawa H.
        • Osaki Y.
        • Tsuchiya K.
        • Joko K.
        • Ogawa C.
        • et al.
        Proposal of Japan Red Cross score for sorafenib therapy in hepatocellular carcinoma.
        Hepatol Res Off J Jpn Soc Hepatol. 2015; 45: E130-E140https://doi.org/10.1111/hepr.12480
        • Edeline J.
        • Blanc J.-F.
        • Johnson P.
        • Campillo-Gimenez B.
        • Ross P.
        • Ma Y.T.
        • et al.
        A multicenter comparison between Child Pugh and ALBI scores in patients treated with sorafenib for hepatocellular carcinoma.
        Liver Int Off J Int Assoc Study Liver. 2016; https://doi.org/10.1111/liv.13170
        • Hsu C.-Y.
        • Lee Y.-H.
        • Hsia C.-Y.
        • Huang Y.-H.
        • Su C.-W.
        • Lin H.-C.
        • et al.
        Performance status in patients with hepatocellular carcinoma: determinants, prognostic impact, and ability to improve the Barcelona Clinic Liver Cancer system.
        Hepatol Balt Md. 2013; 57: 112-119https://doi.org/10.1002/hep.25950
        • Hsu C.-Y.
        • Liu P.-H.
        • Lee Y.-H.
        • Hsia C.-Y.
        • Huang Y.-H.
        • Chiou Y.-Y.
        • et al.
        Aggressive therapeutic strategies improve the survival of hepatocellular carcinoma patients with performance status 1 or 2: a propensity score analysis.
        Ann Surg Oncol. 2015; 22: 1324-1331https://doi.org/10.1245/s10434-014-4151-2