TRIP: a pathological score for transarterial chemoembolization resistance individualized prediction in hepatocellular carcinoma.
BACKGROUND & AIMS
Although potentially very useful in optimizing patient selection and follow-up, the individual response to transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) is generally unpredictable. The aim of this study was to identify tissue predictors of tumour resistance to TACE for use in clinical practice on pretreatment biopsies.


METHODS
We investigated the association of residual tumour in post-TACE-resected HCC with pathological and immunophenotypical features, mainly related to hypoxia and angiogenesis. Comparison of tumour phenotype between post-TACE HCC and both paired pre-TACE biopsies and control TACE-untreated HCC was performed. Cases showing >50% residual tumour (RT) were defined as TACE-resistant.


RESULTS
A consecutive series of 108 HCC from 41 patients was studied. Overall, 45/108 (44%) HCC were classified as TACE-resistant. Among these, 32 (71%) and 40 (89%) showed diffuse CD34 vascular staining and negative VEGF staining respectively (p<0.05). The association of these two parameters in a weighted score (TRIP) was able to predict TACE resistance with 81% accuracy, 89% sensitivity and 59% specificity. The effectiveness of TRIP was validated in an independent series of 28 HCC biopsies from patients subsequently treated with TACE and for whom radiological follow-up was available.


CONCLUSIONS
This study demonstrates the potential value of pretreatment tumour biopsy as predictors of TACE resistance in HCC.
['Sciarra|Amedeo|A|', 'Ronot|Maxime|M|', 'Di Tommaso|Luca|L|', 'Raschioni|Carlotta|C|', 'Castera|Laurent|L|', 'Belghiti|Jacques|J|', 'Bedossa|Pierre|P|', 'Vilgrain|Valérie|V|', 'Roncalli|Massimo|M|', 'Paradis|Valérie|V|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000903:Antibiotics, Antineoplastic D001706:Biopsy D006528:Carcinoma, Hepatocellular D016461:Chemoembolization, Therapeutic D004317:Doxorubicin D005260:Female D006801:Humans D008113:Liver Neoplasms D016015:Logistic Models D008297:Male D008875:Middle Aged D018579:Patient Selection D011379:Prognosis D012189:Retrospective Studies D016896:Treatment Outcome
transarterial chemoembolization Hepatocellular carcinoma biopsy predictive response