The Effectiveness of ART Score in Selecting Patients for Transarterial Chemoembolization Retreatment: A Cohort Study in Taiwan.

The major issue in selecting patients for transarterial chemoembolization (TACE) lies in determining the optimal number of TACE sessions that may benefit patients before switching to other therapies. This is often a subjective decision not based on any standardized protocol. The ART (Assessment for Retreatment with Transarterial chemoembolization) score was recently developed to determine patients who may benefit from multiple sessions of TACE for treatment of hepatocellular carcinoma. The primary aim of the study was to validate the ART score in a Taiwanese cohort. The secondary aims were to evaluate overall survival and clinical determinants of improved survival in patients treated with multiple TACE sessions. The ART score, clinical characteristics, and outcomes of 82 patients with hepatocellular carcinoma who received multiple TACE sessions at Taipei Veterans General Hospital from September 2007 to July 2013 were analyzed. Among the 82 patients evaluated, 69.5% (n = 57) had an ART score of 0 to 1.5 and 34.1% (n = 25) had a score of ≥2.5. The median overall survival was 23.1 months and the overall mortality rate was 62.2% (n = 51). The ART score was not associated with survival (P = 0.58). Multivariate Cox regression analysis revealed that tumor size >7.2 cm (hazard ratio 4.44, P 25%, and lack of radiological response to TACE were independently associated with shorter survival after TACE therapy.