1 Department of Liver Disease and Digestive Interventional Radiology, Xijing Hospital of Digestive Disease, Fourth Military Medical University, Xi'an, China.
2 Department of Biostatistics, University of Liverpool, Liverpool, UK.
3 Department of Gastroenterology and Hepatology, Ogaki Municipal Hospital, Ogaki, Japan.
4 Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
5 National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt.
6 Department of Pathology, Chinese University of Hong Kong, Hong Kong.
7 Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany.
8 Radiology Unit, Department of Specialized, Alma Mater Studiorum - University of Bologna, Italy University Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna.
9 Department of Internal Medicine & Gastroenterology (IMuG), Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria.
10 Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK.
11 Department of Surgery and Cancer, Imperial College London, London, UK.
12 UCL Cancer Institute, Paul O'Gorman Building, London, UK.
13 Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea.
14 Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands.
15 Department of Radiology, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
16 Department of Translational Medicine, Università del Piemonte Orientale (UPO), Novara, Italy.
17 Department of Gastroenterology and Hepatology, Aintree University Hospital, Liverpool, UK.
18 Liver Unit, Clínica Universidad de Navarra IDISNA and CIBEREHD, Pamplona, Spain.
19 Research Department of Oncology, UCL Cancer Institute, University College London, London, UK.
20 NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK.
21 Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, Nottingham, UK.
22 Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
23 Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Osaka, Japan.
24 Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
25 Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong.
The heterogeneity of intermediate-stage hepatocellular carcinoma (HCC) and the widespread use of transarterial chemoembolization (TACE) outside recommended guidelines have encouraged the development of scoring systems that predict patient survival. The aim of this study was to build and validate statistical models that offer individualized patient survival prediction using response to TACE as a variable. Clinically relevant baseline parameters were collected for 4,621 patients with HCC treated with TACE at 19 centers in 11 countries. In some of the centers, radiological response (as assessed by modified Response Evaluation Criteria in Solid Tumors [mRECIST]) was also accrued. The data set was divided into a training set, an internal validation set, and two external validation sets. A new pre-TACE model ("Pre-TACE-Predict") and a post-TACE model ("Post-TACE-Predict") that included response were built. The performance of the models in predicting overall survival (OS) was compared with existing ones. Median OS was 19.9 months. The factors influencing survival were tumor number and size, alpha-fetoprotein, albumin, bilirubin, vascular invasion, etiology, and response as assessed by mRECIST. The proposed models showed superior predictive accuracy compared to existing models (the HAP score and its various modifications) and allowed for patient stratification into four distinct risk categories whose median OS ranged from 7 months to more than 4 years. Conclusion: A TACE-specific and extensively validated model based on routinely available clinical features and response after first TACE permitted patient-level prognostication.