Risk prediction for patients with hepatocellular carcinoma undergoing chemoembolization: development of a prediction model

Backgrounds & Aims: We aimed to generate and validate a novel risk prediction model for patients with hepatocellular carcinoma (HCC) undergoing transarterial chemoembolization (TACE). Methods: Patients receiving TACE as the first-line therapy between 2006 and 2009 were selected from the databases of two major tertiary hospitals in Korea. This study population was randomly assigned into training (n = 340) and validation (n = 145) sets. From a multivariate Cox-regression model for overall survival (OS), tumour Size, tumour Number, baseline Alpha-foetoprotein level, Child-Pugh class and Objective radiological Response after the first TACE session were selected and then scored to generate a 10-point risk prediction model (named as "SNACOR" model) in the training set. Thereafter, the prognostic performance was assessed in the validation set. Results: In the training set, the time-dependent areas under receiver-operating characteristic curves (AUROCs) for OS at 1-, 3- and 6-years were 0.756, 0.754 and 0.742 respectively. According to the score of the SNACOR model, patients were stratified into three groups; low-(score 0-2), intermediate-(score 3-6) and high-risk group (score 7-10) respectively. The low-risk group had the longest median OS (49.8 months), followed by intermediate-(30.7 months) and high-risk group (12.4 months) (log-rank test, P < 0.001). Compared with the low-risk group, the intermediate-risk (hazard ratio [HR] 2.13, P < 0.001) and high-risk group (HR 6.17, P < 0.001) retained significant risks of death. Similar results were obtained in the validation set. Conclusion: A simple-to-use SNACOR model for patients with HCC treated with TACE might be helpful in appropriate prognostification and guidance for decision of further treatment strategies.