Value of ABCR scoring system in assessing the prognosis of hepatocellular carcinoma after transcatheter arterial chemoembolization

Objective To investigate the value of ABCR clinical scoring system in guiding repeated transcatheter arterial chemoembolization( TACE) therapy for patients with hepatocellular carcinoma( HCC) and the treatment strategies for patients with an ABCR score of 1-3.Methods The patients with HCC who underwent TACE in The First Affiliated Hospital of Soochow University from January 2008 to December 2017 were enrolled. In order to investigate the effect of repeated TACE in patients with different ABCR scores,229 patients who underwent repeated TACE consecutively( at least twice,without systemic therapy) were enrolled as group A,which was further divided into group A1 with 92 patients( an ABCR score of ≤0),group A2 with 78 patients( an ABCR score of 1-3),and group A3 with 59 patients( an ABCR score of ≥4). In order to investigate the survival time of patients with an ABCR score of 1-3 who received different regimens after first TACE therapy,118 patients with an ABCR score of 1-3 who received TACE for the first time were enrolled as group B,which was further divided into group B1 with 78 patients( treated with TACE after first TACE therapy),group B2 with 21 patients( treated with TACE combined with sorafenib),and group B3 with 19 patients( treated with sorafenib alone). The survival of the above groups of patients were analyzed. The Fisher's exact test was used for comparison of categorical data between groups,the Kaplan-Meier method was used to plot survival curves,and the log-rank test was used for comparison of survival time between groups. Results The median survival time was32. 0 months( 95% confidence interval [CI]: 27. 7-36. 3) in group A1,10. 3 months( 95% CI: 8. 4-12. 2) in group A2,and 4. 6 months( 95% CI: 3. 7-5. 5) in group A3. Group A1 had a better survival time than group A2( χ2= 106. 99,P < 0. 01),and group A2 had a better survival time than group A3( χ2= 49. 66,P < 0. 01). The median survival time was 10. 3 months( 95% CI: 8. 4-12. 2) in group B1,14. 8 months( 95% CI: 7. 8-21. 8) in group B2,and 6. 0 months( 95% CI: 4. 6-7. 4) in group B3,and group B2 had a better survival time than group B1( χ2= 6. 80,P < 0. 01) and group B3( χ2= 29. 89,P < 0. 01). Conclusion The ABCR score has a certain guiding significance for the treatment of HCC patients. Repeated TACE may be considered for patients with an ABCR score of ≤0,while patients with an ABCR score of ≥4 may not benefit from further TACE therapy,and TACE combined with sorafenib might bring maximum benefits to patients with an ABCR score of 1-3.