The model for end-stage liver disease-based Japan Integrated Scoring system may have a better predictive ability for patients with hepatocellular carcinoma undergoing locoregional therapy.
BACKGROUND
The Japan Integrated Scoring (JIS) system was revealed as a better model for outcome prediction compared with the Cancer of Liver Italian Program system for hepatocellular carcinoma (HCC), and the Model for End-Stage Liver Disease (MELD) was better as a prognostic predictor for patients with cirrhosis compared with the Child-Turcotte-Pugh (CTP) system, which is a parameter used in the JIS system. The objective of the current study was to investigate the performance of the modified MELD-based JIS system.


METHODS
In the modified JIS system, the CTP class in the original JIS was replaced with MELD cut-off scores of <10, 10 to 14, and >14. The modified JIS system was compared with the original system in 276 patients with HCC who underwent locoregional therapy (transarterial chemoembolization or percutaneous injection).


RESULTS
The mean +/- standard error original JIS score was 1.8 +/- 1.0 (range, 0-4), compared with 2.0 +/- 1.1 (range, 0-5) for the modified JIS system (P < .001). Using mortality as the endpoint, the area under receiver operating characteristic curve (AUC) for the modified JIS system was 0.804 compared with 0.741 for the original JIS system (P = .008) at 12 months, and the AUC was 0.853 and 0.765, respectively (P < .001), at 24 months. Survival analysis showed that the modified JIS system had a better discriminatory ability for patients in different score groups and was more accurate for outcome prediction in the Cox multivariate model.


CONCLUSIONS
The current results indicated that the MELD-based, modified JIS system has improved predictive ability compared with the original system and is a more feasible model for clinical staging in patients with HCC who are undergoing locoregional therapy.
Huo
Teh-Ia
TI
Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. tihuo@vghtpe.gov.tw
Lin
Han-Chieh
HC
Huang
Yi-Hsiang
YH
Wu
Jaw-Ching
JC
Chiang
Jen-Huei
JH
Lee
Pui-Ching
PC
Lee
Shou-Dong
SD
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D007558:Italy; D007564:Japan; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis*; D017093:Liver Failure / Q000150:complications / Q000175:diagnosis*; D008113:Liver Neoplasms / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D016019:Survival Analysis; D016896:Treatment Outcome