Evaluation of model for end stage liver disease (MELD)-based systems as prognostic index for hepatocellular carcinoma.
BACKGROUND
The Cancer of Liver Italian Program (CLIP) and Japan Integrated Scoring System (JIS) used the Child-Turcotte-Pugh (CTP) score to evaluate the liver function.


OBJECTIVE
We aimed to evaluate the performance of Model for End Stage Liver Disease (MELD) based CLIP and JIS to predict the prognosis of hepatocellular carcinoma (HCC).


METHODS
Consecutive patients with HCC who presented to our Hepatoma Clinic from January 2003 to April 2005 were studied. MELD-based CLIP and JIS were generated by replacing the original CTP score with MELD score at three categories (<10, 10-14 and >14).


RESULTS
Among 471 HCC patients (85.1% males; aged 58.8 +/- 12.2 years), 73% had chronic hepatitis B, 37.4% had >1 nodule, 84.1% had tumor size >2 cm, 55.0% had Child's B cirrhosis, 12.7% underwent tumor resection and 20.6% received locoregional therapy. The cumulative survival at 3 and 6 months were 67% and 55%, respectively. For 3-month survival, the area under the receiver operating characteristic curves (AUC) of MELD-CLIP (0.69) and MELD-JIS (0.69) were superior to the original systems (0.64, P = 0.004 and 0.64, P = 0.0018, respectively). For 6-month survival, AUC of MELD-CLIP (0.64) and MELD-JIS (0.62) were also superior to the original systems (0.54, P = 0.003 and 0.59, P = 0.002, respectively). The MELD-based systems performed best among patients who received locoregional therapy to HCC. Advanced cirrhosis (hypoalbuminemia, hyperbilirubinemia, ascites, coagulopathy and elevated creatinine), and cancer (portal vein thrombosis, elevated alpha-fetoprotein, large and multiple tumors) were associated with higher mortality.


CONCLUSIONS
MELD-based systems performed better than Child-Pugh based systems as prognostic indexes for HCC.
Limquiaco
Jenny L
JL
Department of Medicine and Therapeutics and Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China.
Wong
Grace L H
GL
Wong
Vincent W S
VW
Lai
Paul B S
PB
Chan
Henry L Y
HL
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000503:physiopathology*; D008103:Liver Cirrhosis / Q000175:diagnosis; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome