title: The model for end-stage liver disease based cancer staging systems are better prognostic models for hepatocellular carcinoma: a prospective sequential survey.
abstract: OBJECTIVE
  Liver cirrhosis is a major component in staging for hepatocellular carcinoma (HCC). The model for end-stage liver disease (MELD) is a better prognostic predictor for cirrhotic patients compared to the Child-Turcotte-Pugh (CTP) system, which is a parameter in Cancer of Liver Italian Program (CLIP), Barcelona Clinic Liver Cancer (BCLC), and Japan Integrated Scoring (JIS) system.
  
  
  OBJECTIVE
  To investigate if the MELD-based models have a better prognostic ability.
  
  
  METHODS
  In the MELD-based model, the CTP class was replaced with MELD score at cutoffs of <10, 10-14, and >14. The modified systems were prospectively compared with the original counterpart in 430 consecutive HCC patients. Using 6-month mortality as the end point, the area under receiver operating characteristic curve (AUC) between the original and modified system was compared sequentially on a 3-monthly basis.
  
  
  RESULTS
  At the final inspection, the modified CLIP and JIS system had a significantly higher AUC compared to the original system (0.92 vs 0.893 for CLIP, P < 0.018; 0.88 vs 0.842 for JIS, P= 0.002), but there was no significant difference for the BCLC system (0.848 vs 0.841, P= 0.561). Survival analysis showed modified CLIP and JIS, and to a lesser extent, modified BCLC system, had a higher homogeneity likelihood ratio and discriminatory ability linear trend, and a lower Akaike information criterion in the Cox multivariate model, indicating a better discriminatory ability for different stage categories.
  
  
  CONCLUSIONS
  The MELD-based CLIP and JIS staging systems have an improved predictive ability compared to the original system and are feasible models for HCC staging in the MELD era.
authors.affiliation: Department of Medicine, Taipei Veterans General Hospital, Taipei,Taiwan.
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Cheng-Yuan
authors.initials: CY
authors.lastname: Hsia
authors.forename: Jaw-Ching
authors.initials: JC
authors.lastname: Wu
authors.forename: Pui-Ching
authors.initials: PC
authors.lastname: Lee
authors.forename: Chin-Wen
authors.initials: CW
authors.lastname: Chi
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
mesh_terms: D019540:Area Under Curve; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality*; D008297:Male; D015233:Models, Statistical; D009367:Neoplasm Staging; D011379:Prognosis; D012372:ROC Curve; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D015996:Survival Rate