Development of the MANTAP Score for Predicting One-Year Mortality in Intermediate-Stage Hepatocellular Carcinoma Patients Undergoing Transarterial Chemoembolization - 04/02/26
, Rino Alvani Gani, Kuntjoro Harimurti, Noorwati Sutandyo, Evy Yunihastuti, Hamzah Shatri, Cosmas Rinaldi LesmanaHighlights |
• | Most intermediate HCCs in developing countries are diagnosed at large tumor size |
• | Previous post-TACE outcome prediction models are based on small tumors |
• | Baseline AFP >1000 ng/mL correlates with OS in patients who received TACE |
• | The MANTAP model incorporates tumor burden and liver function for TACE eligibility |
• | The MANTAP model may perform better in populations with a high tumor burden |
Abstract |
Background and Aim(s) |
: Transarterial chemoembolization (TACE) is the main treatment for intermediate-stage hepatocellular carcinoma (HCC), but its suitability varies due to tumor burden and liver function heterogeneity. TACE may worsen liver function in large tumors. This study aims to develop a model to predict one-year mortality in intermediate-stage HCC patients undergoing TACE as first-line therapy.
Methods |
: A retrospective cohort study analyzed data from the Indonesian National Hepatocellular Carcinoma Registry (RINKAS) at Cipto Mangunkusumo and Dharmais Cancer Hospitals (2006–2022). Prognostic factors for one-year mortality were identified using bivariate and multivariate Cox regression. The resulting model was evaluated for discrimination, calibration, and internal validation using AUROC, Hosmer-Lemeshow test, calibration curve, and bootstrapping.
Results |
: Among 538 intermediate-stage HCC patients, 191 received TACE, with a one-year survival rate of 49.8% and a median survival of 362 days. Significant predictors of mortality included ALBI grade 2–3 (HR 1.97; p=0.003), nodule size ≥11 cm (HR 1.57; p=0.04), and AFP ≥1000 ng/mL (HR 2.41; p < 0.001). The MANTAP model, based on these variables, stratifies patients into low-risk (score 0–1, mortality 29.6%), moderate-risk (score 2, mortality 52.9%), and high-risk (score 3–4, mortality 75.1%) groups. The model showed acceptable predictive performance (AUROC 0.72), good calibration (Hosmer-Lemeshow p=0.343), and robust validation.
Conclusions |
: The MANTAP score proposes a simple risk stratification tool for estimating one-year mortality in intermediate-stage HCC patients undergoing TACE as first-line therapy.
Le texte complet de cet article est disponible en PDF.Keywords : hepatocellular carcinoma, TACE, prognosis, prediction model, scoring system
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