The ART-SCORE is not an effective tool for optimizing patient selection for DEB-TACE retreatment. A multicentre Spanish study

Abstract Introduction The appropriate selection of hepatocellular carcinoma (HCC) patients who are eligible for transarterial chemoembolization (TACE) remains a challenge. The ART score has recently been proposed as a method of identifying patients who are eligible or not for a second TACE procedure. Objective To assess the validity of the Assessment for Retreatment with TACE (ART) score in a cohort of patients treated with drug-eluting bead TACE (DEB-TACE). Secondary objective: to identify clinical determinants associated with overall survival (OS). Method A retrospective, multicentre study conducted in Spain in patients with HCC having undergone two or more DEB-TACE procedures between January 2009 and December 2014. The clinical characteristics and OS from the day before the second DEB-TACE of patients with a high ART score (ART ≥ 2.5) and a low ART score (ART 0–1) were compared. Risk factors for mortality were identified using Cox's proportional hazards model. Results Of the 102 patients included, 51 scored 0–1.5 and 51 scored ≥2.5. Hepatitis C was more frequent in patients scoring ≥2.5. Median OS from the day before the second DEB-TACE was 21 months (95% CI, 15–28) in the group scoring 0–1.5, and 17 months (95% CI, 10–25) in the group scoring ≥2.5 ( P = 0.3562). Platelet count and tumour size, but not the ART score, were independent baseline predictors of OS. Conclusions The ART score is not suitable for guiding DEB-TACE retreatment according to Spanish clinical practice standards.