Establishment and validation of a risk prediction model in... : European Journal of Gastroenterology & Hepatology (original) (raw)

Original Articles: Hepatology

Establishment and validation of a risk prediction model in patients with hepatocellular carcinoma treated with transarterial radioembolization

Lee, Jae Seunga; Lee, Han Ahb; Jeon, Mi Younga,,c; Lim, Tae Seopa,,c; Kim, Beom Kyunga,,c,,d; Park, Jun Yonga,,c,,d; Kim, Do Younga,,c,,d; Ahn, Sang Hoona,,c,,d; Um, Soon Hob; Han, Kwang-Hyuba,,c,,d; Seo, Yeon Seokb,,*; Kim, Seung Upa,,c,,d,,*

aDepartment of Internal Medicine, Yonsei University College of Medicine

bDepartment of Internal Medicine, Korea University College of Medicine

cYonsei Liver Center, Severance Hospital

dInstitute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea

*Seung Up Kim and Yeon Seok Seo contributed equally to the writing of this article.

Received 7 June 2019 Accepted 22 August 2019

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Correspondence to Seung Up Kim, MD, PhD, Department of Internal Medicine, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, Seoul, Korea, Tel: +82 2 2228 1944; fax: +82 2 393 6884; e-mail: [email protected]

European Journal of Gastroenterology & Hepatology 32(6):p 739-747, June 2020. | DOI: 10.1097/MEG.0000000000001585

Abstract

Background/aims

Few studies have reported the treatment outcomes of transarterial radioembolization (TARE) using yttrium-90 (90Y) for hepatocellular carcinoma (HCC). We established and validated a new risk prediction model for patients with HCC treated with TARE.

Methods

Between 2010 and 2017, 113 and 35 patients with intrahepatic HCC treated with TARE were selected for the training and validation cohorts, respectively. The modified response evaluation criteria in solid tumors (mRECIST) were used for response evaluation.

Results

In the training cohort, the median age was 64.1 years (92 males and 21 females) and the mean survival after TARE was 50.3 months. The cumulative survival rates at six and 12 months were 92.0 and 84.0%, respectively. A new risk prediction model for patients with HCC treated with TARE (Y-scoring system) was established from the training cohort using five independent baseline variables [serum albumin < 3.5 g/dL, hazard ratio = 5.446; alpha-fetoprotein > 200 ng/mL (hazard ratio = 5.071); tumor number ≥ 3 (hazard ratio = 2.933); portal vein thrombosis (hazard ratio = 4.915); and hepatic vein invasion (hazard ratio = 8.500)] and two on-treatment variables [no des-gamma-carboxy prothrombin response (hazard ratio = 15.346) and progressive disease at three months (hazard ratio = 4.154)] for mortality (all P < 0.05). The predictive accuracy of the Y-scoring system was acceptable to predict six [area under the curve (AUC) = 0.845], nine (AUC = 0.868), and 12-month mortality (AUC = 0.886) (all P < 0.05). The predictive accuracy of the system was similarly maintained in the validation cohort (AUC 0.737–0.901 at 6–12 months).

Conclusion

Our new risk prediction model can be used to stratify different prognoses in patients with HCC treated with TARE. Validation studies are required.