title: 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.
abstract: 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.
authors.affiliation: Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan. tihuo@vghtpe.gov.tw
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.forename: Jaw-Ching
authors.initials: JC
authors.lastname: Wu
authors.forename: Jen-Huei
authors.initials: JH
authors.lastname: Chiang
authors.forename: Pui-Ching
authors.initials: PC
authors.lastname: Lee
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
mesh_terms: 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