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Normal IBI predicted OS in patients undergoing TACE for HCC

Normalization of inflammation-based index score after transarterial chemoembolization therapy among patients with hepatocellular carcinoma predicted a greater overall survival, according to study data.

“We … designed this study to independently and prospectively validate the [inflammation-based index] as an objective prognostic marker in HCC patients undergoing [transarterial chemoembolization], and secondly to evaluate whether dynamic changes in the IBI following initial [transarterial chemoembolization] can be used as a biomarker to predict survival after treatment,” the researchers wrote.

Researchers analyzed baseline staging, biochemical and clinicopathological elements, including inflammation-based index (IBI), among a derivation group of 64 patients undergoing transarterial chemoembolization (TACE) for HCC. Additional analyses were used in two independent cohorts from Korea (n=76) and Japan (n=577) also undergoing TACE therapy to further investigate IBI as a predictor of survival. The median age of patients in the derivation group was 64 years and 67% had intermediate stage HCC, according to the research.

In the derivation group, IBI predicted OS pre-treatment (P=.001). Patients with an IBI of 1 or 2 at baseline had a higher median survival rate compared with patients with an IBI score of 0, who did not reach median survival at the end of a 3-month follow-up period (HR=4.2; 95% CI, 2.1-8.3). Patients with abnormal IBI score after TACE therapy had a median OS of 11.3 months compared with patients who achieved normalization of IBI, who did not reach median survival (HR=12.1; 95% CI, 2.7-53.3).   

Univariate analysis showed radiological response to TACE (P<.001), Cancer of the Liver Italian Program (CLIP) score before treatment (P<.01), tumor diameter >5 cm (P=.05) and alfa-fetoprotein levels ≥400 (P<.001) to be predictors of survival.

Normalization of IBI after TACE therapy was associated with improved OS (P<.001) and with radiological response by modified RECIST criteria, according to the research.

Of the 76 patients from Korea, 46% had normal IBI at baseline, 30 had an IBI score of 1 and 11 had an IBI of 2. After treatment with TACE, 45% of patients reached IBI normalization. However, 55% had abnormal IBI after treatment. Twenty percent of patients who maintained abnormal IBI after therapy had a score of 2, 40% maintained an IBI score of 1, of which 33% had a 1-point worsening score and 7% had a 2-point worsening score from baseline, according to the research. Of the patients in the Japanese cohort, 215 patients showed improved IBI after TACE, whereas IBI score of the other 272 patients worsened; 64% of these patients showed a consistent decreased score of either 1 or 2 after therapy.    

Normalization of IBI was a predictor of OS among both validation cohorts (P<.001).

“We have demonstrated that pre-treatment IBI is an independent prognostic marker in patients receiving TACE,” the researchers concluded. “Our study illustrates that the reversal of cancer-related inflammation, as measured by the IBI, is associated with better response rates and improved survival, and can be used to select patients who may benefit from repeat TACE, protecting others from unnecessary risks and adverse events.”  

Disclosure: The researchers report no relevant financial disclosures.