Defining the severity of liver dysfunction in patients with hepatocellular carcinoma by the model for end-stage liver disease-derived systems.
BACKGROUND
The model for end-stage liver disease (MELD) and serum sodium (Na) are important markers for liver functional reserve in patients with hepatocellular carcinoma. We aimed to determine the best model to define the severity of liver dysfunction in terms of outcome prediction among the 4 currently used systems (MELD, MELDNa, MELD-Na and ReFit MELDNa).


METHODS
A total of 2308 prospectively enrolled patients with hepatocellular carcinoma were analysed. The prognostic ability was compared by the Akaike information criterion.


RESULTS
MELDNa had the best prognostic accuracy overall, and for patients receiving curative and non-curative treatments, followed by MELD-Na, MELD and ReFit MELDNa. When patients were categorized into <8, 8-12, 12-16, 16-20 and >20, the adjusted risk ratios for MELDNa were 1.065 (p=0.46), 0.996 (p=0.973), 1.38 (p=0.048) and 1.563 (p=0.003) for the scores of 8-12, 12-16, 16-20 and >20, respectively, compared to the group with scores <8. The adjusted risk ratio for MELDNa was 1.014 (95% confidence interval, 1.001-1.027; p=0.034) per unit score increment in the Cox model.


CONCLUSIONS
The MELDNa is the best marker to define the severity of liver dysfunction in hepatocellular carcinoma patients independent of treatment strategy. The ReFit MELDNa does not enhance the predictive accuracy of the MELD.
Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Yun-Hsuan
YH
Lee
Chia-Yang
CY
Hsu
Cheng-Yuan
CY
Hsia
Yi-Hsiang
YH
Huang
Chien-Wei
CW
Su
Han-Chieh
HC
Lin
Che-Chuan
CC
Loong
Yi-You
YY
Chiou
Teh-Ia
TI
Huo
D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000503:physiopathology*; D058625:End Stage Liver Disease / Q000145:classification* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008099:Liver / Q000503:physiopathology*; D008113:Liver Neoplasms / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008954:Models, Biological; D011379:Prognosis; D012720:Severity of Illness Index; D015996:Survival Rate