Purpose: Evaluate the utility of previously established objective scoring systems for transarterial chemoembolization, ART and ABCR, for predicting survival outcomes in repeat Y90 transarterial radioembolization (TARE). ART and ABCR are numerical scores generated from each patient’s objective measures of hepatic reserve, tumor burden, as well as objective imaging response to initial TARE [1,2]. ART score ranges from 0 to 8 and the ABCR score ranges from -3 to 6, where higher scores have generally worse prognosis.
Materials and Methods: Between 3/2011 and 4/2023, 30 patients underwent repeat TARE with Y90 glass microspheres to treat residual or recurrent HCC in the same hepatic arterial segmental or lobar distribution. Patients’ relevant labs were recorded before and after initial TARE for ART and ABCR score computation. Tumor response was documented according to modified RECIST criteria. Scores were calculated after initial TARE using relevant radiologic and clinical data as seen in attached table. Adverse events were recorded by standardized criteria using the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Kaplan Meier survival analysis was performed to investigate the utility of ART and ABCR scoring to predict survival outcomes after second TARE.
Results: Using log rank testing, there was statistically higher survival in low ART (≤1.5) score cohort compared to the high score (≥2.5) cohort with median survival of 42.1 months in the low score and 8.7 months in the high score cohort (p< 0.001). Additionally, there was statistically higher survival in low ABCR (≤0) score cohort compared to the high score (≥1) cohort with median survival of 42.1 months in the low score and 10.1 months in high score cohort (p< 0.001). There was no statistically significant difference in CTCAE grade 2 or higher adverse events between high and low ART and ABCR scores (p=0.757 & p=0.298). Average time between initial and repeat TARE was 9.1 months (95% CI: 5.2-13.0 months).
Conclusion: An ART score ≥2.5 and ABCR score ≥1, after initial TARE, can help predict which patients may have poor survival outcomes after repeat treatment.