Accordingly, curative treatments, like orthotopic liver transplantation (OLT), resection, or radiofrequency ablation (RFA) are reserved for patients with early stage HCC (BCLC stage 0/A). Unfortunately, HCC is commonly diagnosed at intermediate (BCLC stage B) or advanced (BCLC stage C) tumor stages6, 7 where only palliative treatment options can be offered, resulting in a limited overall survival (OS) of 11-20 months. Transarterial chemoembolization (TACE) is the recommended treatment modality selleckchem for asymptomatic, large, or multifocal HCC without macrovascular

invasion or extrahepatic metastasis (intermediate HCC, BCLC stage B). As most patients with HCC also suffer from liver cirrhosis, not only tumor characteristics but also the degree of liver dysfunction are of prognostic importance for patients undergoing TACE. Several studies showed8 that baseline tumor characteristics like tumor size or extent, alpha-fetoprotein (AFP) values, as well as baseline Child-Pugh score, presence of ascites, and several baseline lab values, e.g., AST9 are associated with OS of HCC patients. Furthermore, tumor-related

dynamics after TACE are important for patient prognosis, as radiologic and biochemical (AFP) tumor responses have been associated with improved patient outcome.10-12 Finally, deterioration buy AZD3965 of liver function after TACE may negatively impact the patient prognosis and liver function may further worsen after repeated TACE sessions or even find more obviate any consequent antitumor treatment. The aim of this study was to establish a clinically usable point score to guide the decision for retreatment with TACE in patients with HCC. Using a stepwise multivariate regression model we developed a novel point score predicting patient outcome with respect to patient characteristics prior to the second TACE as well as the dynamic of tumor and liver-function related parameters after the first TACE session. All patients, >18 years old at the time of the first TACE cycle, diagnosed with HCC by histology or dynamic imaging (computed

tomography [CT] / magnetic resonance imaging [MRI] scans) according to the European Association for the Study of the Liver (EASL) diagnostic criteria4 who were treated with conventional TACE (cTACE), transarterial embolization (TAE), or TACE with drug-eluting beads (DEB-TACE) (hereafter summarized and referred to as TACE) at the Department of Gastroenterology and Hepatology of the Medical University of Vienna between January 1999 and December 2009 (n = 231) were screened for eligibility (Fig. 1). Patients with HCC at BCLC stage A or B and preserved liver function (Child-Pugh stage A or B) who received at least two TACE sessions within 3 months (≤90 days) were included and formed the training cohort for all further analysis.