Development of the MANTAP Score for Predicting One-Year Mortality in Intermediate-Stage Hepatocellular Carcinoma Patients Undergoing Transarterial Chemoembolization.

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.