title: The sequential changes of the model for end-stage liver disease score correlate with the severity of liver cirrhosis in patients with hepatocellular carcinoma undergoing locoregional therapy.
abstract: BACKGROUND
  The model for end-stage liver disease (MELD) has been used to prioritize cirrhotic patients awaiting liver transplantation. It is not clear whether MELD correlates with liver functional reserve that changes over time. This study investigated the correlation of sequential changes between MELD and Child-Turcotte-Pugh (CTP) scores in patients with hepatocellular carcinoma (HCC).
  
  
  METHODS
  A total of 192 HCC patients undergoing transarterial chemoembolization or percutaneous injection therapy were studied.
  
  
  RESULTS
  The MELD and CTP scores of study patients at pretreatment, early (median, 2 wk) and late (median, 8 wk) stage after treatment were 10.1+/-3.5, 12.9+/-3.2, and 11.7+/-3.1, and 6.2+/-1.1, 7.5+/-1.1, and 6.9+/-1.2, respectively. There was a significant correlation of the serial changes for the period between pretreatment and early stage (rho=0.605, P<0.001), and between early to late stage (rho=0.512, P<0.001) after treatment. The corresponding increase and decrease of MELD score was 2.1 and 2.0, respectively, per unit change of the CTP score. The correlation was still significant in the stratified analysis according to various clinical parameters. In the Cox multivariate model, tumor size >5 cm [relative risk (RR)=2.58, P<0.001], multiple HCCs (RR=1.78, P=0.013), CTP class B or C (RR=3.06, P<0.001), and MELD score >15 (RR=2.17, P=0.023) were independent poor prognostic predictors.
  
  
  CONCLUSIONS
  Serial determinations of the MELD score well correlate with the changes of CTP score. The MELD score may be useful in measuring liver functional reserve and outcome prediction in HCC patients undergoing locoregional therapy.
authors.affiliation: National Yang-Ming University, School of Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China. tihuo@vghtpe.gov.tw
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
authors.forename: Pui-Ching
authors.initials: PC
authors.lastname: Lee
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.forename: Jaw-Ching
authors.initials: JC
authors.lastname: Wu
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Jen-Huei
authors.initials: JH
authors.lastname: Chiang
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology* / Q000628:therapy; D016461:Chemoembolization, Therapeutic; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology* / Q000628:therapy; D017093:Liver Failure / Q000209:etiology / Q000473:pathology* / Q000628:therapy; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology* / Q000628:therapy; D016031:Liver Transplantation; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D012720:Severity of Illness Index