TACE for HCC in a regional centre: 5 year audit and assessment of baseline predictors of outcome Iain DS Morrison, #R Kasthuri, EH Forrest, S Barclay, R Gillespie, *P Mills, *M Priest, J Evans, AJ Stanley. Depts of Gastroenterology Glasgow Royal Infirmary and *Gartnavel General Hospital Glasgow (GGH), #Radiology Dept, GGH and Beatson Oncology Centre, Glasgow Background & Aim: As diagnosis of hepatic cirrhosis becomes more common, the incidence of HCC (Hepatocellular Carcinoma) is also increasing. TACE (Trans- Arterial-Chemo-Embolization) is a useful treatment for selected patients unsuitable for surgical management. Outcomes from TACE vary, and prognostic scores may aid decision making. A new prognostic tool, the HAP Score (Hepatoma arterial- embolization prognostic score) [1] has been suggested as a predictor of outcome which may be superior to the Child-Pugh or BCLC (Barcelona clinic liver cancer) scores. See table 1 and 2. Our aim was to report the outcome of TACE in the treatment of HCC for patients diagnosed in the West of Scotland region between January 2008 and December Results A total of 282 patients were diagnosed with HCC during the study period. 101 of these patients (81 male, 20 female) with mean age 66.0 (SD 10.1 years, range 37 to 85) were treated with TACE locally. Aetiology, BCLC and Child Pugh scores are detailed in Table 3. A further 3 patients were treated with TACE out-with our regional centre, therefore were excluded from further analysis. Overall survival is highlighted in table 4. Table 1 - Hepatoma Arterial-embolisation Prognostic Score MarkerThresholdPoints Serum Albumin< 36 g/l1 Serum Alpha Feto- Protein > 400 ng/ml1 Dominant Tumour Size> 7cm1 Serum Bilirubin> 17 μmol/L1 Table 2 - PointsHAP Class 0A 1B 2C 3 or 4D Table 3 - Aetiology of HCC & characterisitcs Alcoholic liver disease30% Unknown21% Non-alcoholic liver disease15% Hepatitis C9% Haemochromatosis8% Mixed aetiology5% Primary biliary cirrhosis3% Hepatitis B3% Autoimmune Hepatitis2% Child Pugh Class A76% Child Pugh Class B21% Child Pugh Class C3% BCLC Class A25% BCLC Class B58% BCLC Class C13% BCLS Class D4% Table 4 - Duration following diagnosis Overall Survival 6 months90% 1 year75% 2 year48% 5 year17% Table 5 - mRECIST Response% Complete Response18 Partial response43 Static disease14 Progressive disease14 Methods: Patients with HCC were identified from a prospectively compiled regional MDT database. Additional information was obtained from electronic patient records, blood results and radiology systems. Patients were risk stratified by Child-Pugh grade, BCLC and HAP scores. Response to treatment was assessed by the EASL(European Association of the Study of the Liver) recommended mRECIST (modified Response Evaluation Criteria in Solid Tumours) criteria.[2] Relationship between risk scores and patient outcomes were assessed using Log-Rank tests performed with median survivals. A total of 228 TACE procedures were performed (mean 2.3 per patient; range 1-6). In 10 (10 %) of patients, TACE was used in combination with radiofrequency ablation and in two (2%) cases was successfully used as a bridge to transplant. The remaining 88% patients had TACE as sole therapy. Three patients (3%) died within 30 days of TACE and 9 (9%) had serious side effects including: prolonged admission with gram negative sepsis, gall bladder infarction, liver infarction, endocarditis and life-threatening hypostatic pneumonia. A total of 22% (51 of 228) had mild post-embolization syndrome. Radiological follow-up post TACE was performed on 208 occasions, results table 5. On analysis of the relationship between HCC risk stratification scores and patient outcome in this cohort, the HAP Score performed best with Log-Rank (Mantel Cox) p value=0.0023; Child Pugh (p=0.19) and BCLC score(p=0.21) There was a 3 fold increase in median survival in patients in the HAP A group when compared to those in the HAP D group. Conclusion We report patient survival following TACE for treatment of HCC which compares favourably with published studies [1]. The HAP score for TACE appears promising in our population and superior to existing scores References [1] Kadalayil L Benini R et al. A simple prognostic scoring system for patients receiving transarterial embolisation for hepatocellular cancer. Ann Oncol Oct;24(10): [2] Lencioni R, Llovet JM. Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 2010;30:52–60