Determination of the optimal model for end-stage liver disease score in patients with small hepatocellular carcinoma undergoing loco-regional therapy.
The model for end-stage liver disease (MELD) has been a prevailing system to prioritize cirrhotic patients awaiting liver transplantation. An "exceptional" MELD score of 20 and 24 points is assigned for stage T1 and T2 patients with small hepatocellular carcinoma (HCC), respectively. However, this strategy is based on scarce data and the optimal score for these patients remains uncertain. We investigated 238 patients with small HCC who were candidates for liver transplantation and underwent arterial chemoembolization or percutaneous injection therapy using acetic acid or ethanol. Tumor stage (P = .001) and Child-Turcotte-Pugh (CTP) class (P < .001) were independent risk factors predicting tumor progression or death in survival analysis. The risk of disease progression in HCC patients stratified by tumor stage was mapped and equated with the risk of mortality of 456 cirrhotic patients without HCC. The 6- and 12-month rates of disease progression were 4% and 6%, respectively, for stage T1 HCC patients (n = 50; mean MELD: 9.5). These rates were close to and no higher than the mortality rate in MELD category 8-12 at the corresponding time period (7.1% and 11.3%, respectively; n = 141). For stage T2 patients (n = 188; mean MELD: 9.3), the corresponding rates were 5.3% and 13.8%, respectively, which were close to and no higher than the mortality rate in MELD category 10-14 (9.0% and 13.9%, respectively, n = 166). In conclusion, the risk of disease progression is quite low for selected HCC patients undergoing loco-regional therapy. A lower MELD score may be suggested to be equivalent to the risk of short- and mid-term mortality in the cirrhosis group.
Huo
Teh-Ia
TI
National Yang-Ming University School of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China. tihuo@vghtpe.gov.tw <tihuo@vghtpe.gov.tw>
Wu
Jaw-Ching
JC
Lin
Han-Chieh
HC
Lee
Fa-Yauh
FY
Hou
Ming-Chih
MC
Huang
Yi-Hsiang
YH
Lee
Pui-Ching
PC
Chang
Full-Young
FY
Lee
Shou-Dong
SD
D019342:Acetic Acid / Q000008:administration & dosage / Q000627:therapeutic use; D000279:Administration, Cutaneous; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D016461:Chemoembolization, Therapeutic; D003661:Decision Support Techniques; D018450:Disease Progression; D000431:Ethanol / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000209:etiology* / Q000401:mortality; D008113:Liver Neoplasms / Q000150:complications* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012307:Risk Factors
D000431:Ethanol; D019342:Acetic Acid