Assessment for Retreatment with Trans arterial Chemoembolization Score Effectiveness for Selecting Hepatocellular Carcinoma Patients Undergoing Repeated Therapy (ART Score Predicting Repeated TACE Impact on Overall Survival)

Repeated transarterial chemoembolization (TACE) treatment is often needed to increase tumor response and survival of unresectable hepatocellular carcinoma (HCC) patients. However, not all patients experience similar benefit from retreatment. This study aimed to determine the effectivity of the Assessment for Retreatment with TACE (ART) score and clinical determinant in predicting repeated TACE impact on overall survival (OS). This study was a retrospective analysis towards HCC patients undergoing at least 2 TACE sessions was performed. The ART score was calculated one day before each repeated TACE session, and patients were divided into 0-1.5 and ≥ 2.5 groups. Out of thirty-two HCC patients, 59.4% (n=19) patients revealed ART score 0-1.5 points, while 40.6% (n=13) patients had score ≥ 2.5 points prior to TACE-2 session. Median OS of the whole subject was 7.6 months (95% CI: 5.9-9.3) with overall 1-year survival rate of 28.2%. The ART score was found to be a significant predictor of survival (median OS and ART score of 0-1.5 vs. ≥ 2.5 points; 11 vs 4.9 months; respectively, P = 0.020), although in sub-analysis according to time intervals (≤90 vs. >90 days) showed no statistically difference that might be due to low sample size. Moreover, AFP levels >200 ng/mL was the only one clinical determinant that associated with poor survival. The ART score has potential to be a significant predictor of OS as well as AFP levels for HCC patients who undergo retreatment with TACE.