Background/Aims: Transarterial chemoembolization
(TACE) is a major therapeutic modality for patients with unresectable hepatocellular carcinoma
, which needs repeated treatments. Model to Estimate Survival in Ambulatory Hepatocellular carcinoma
) was recently developed as a model for predicting survival. We aimed to develop a novel index for TACE retreatment
Patients and Methods:
From 2005 to 2008, 783 patients with hepatocellular carcinoma
who had undergone 1 previous TACE procedure were enrolled. We calculated their pre-TACE and post-TACE-MESIAH
and calculated the MESIAH
ratio by dividing the post-TACE by pre-TACE score. The discriminatory abilities of the MESIAH
ratio and post-TACE-MESIAH
were compared with ART and ABCR scores.
Among 783 patients, 355 (45.3%) received a second TACE (test set), and 195 (24.9%) patients received a third TACE treatment (validation set). In the test set, patients with a MESIAH
ratio <0.9 obtained longer overall survival than patients with a MESIAH
ratio ≥0.9 [26.0 vs. 9.0 mo, respectively; hazard ratio 1.66 (1.29-2.14)], and patients with a post-TACE-MESIAH
<4.5 showed longer overall survival than patients with a post-TACE-MESIAH
≥4.5 [38.0 vs. 7.0 mo, respectively; hazard ratio, 3.17 (2.45-4.09)]. The post-TACE-MESIAH
[C-index 0.663 (0.628-0.697)] was better than the ART [C-index 0.596 (0.554-0.638)] and ABCR scores [C-index 0.576 (0.536-0.617)] at estimating prognosis. Our results were confirmed by the validation set.
score ≥4.5 after TACE identifies patients with a poor prognosis. Randomized studies are needed to establish whether additional TACE may affect survival.