title: A comparison of clinical manifestations and prognoses between patients with hepatocellular carcinoma and Child-Pugh scores of 5 or 6.
abstract: The objective of this work is to compare the outcomes between the Child-Pugh score 5 (A5 group) and Child-Pugh score 6 (A6 group) in patients with hepatocellular carcinoma (HCC). Whether HCC patients with A5 and A6 groups have different prognoses is still obscure. We enrolled 2462 consecutive treatment-naive HCC patients from 2007 to 2012. Among them, 1486 patients had Child-Pugh grade A, including 1016 in the A5 group and 470 in the A6 group. Factors in the prognoses were analyzed by multivariate analysis. Compared with those in the A6 group, patients in the A5 group were younger, had higher proportions of tumors within the Milan criteria, and more of them underwent curative therapies. The cumulative survival rates at 5 years were 51.3% and 37.1% for patients in the A5 and A6 groups, respectively (P < 0.001). Multivariate analysis showed that the independent risk factors associated with poor overall survival were nonhepatitis C virus carrier, serum albumin ≤ 4 g/dL, aspartate aminotransferase > 45 U/L, α-fetoprotein > 20 ng/mL, multinodularity, tumor size > 3 cm, vascular invasion, and noncurative therapies, but not the Child-Pugh numeric score. The Child-Pugh numeric score had a significant prognostic effect only in patients who had tumors beyond the Milan criteria and received noncurative therapies. HCC patients with A5 group had a better overall survival rate than those with A6 group due to the early tumor stage and higher rate of receiving curative treatments. Tumor factors and treatment modalities were more important than the Child-Pugh numeric score.
authors.affiliation: From the Division of Gastroenterology (H-HH, S-DL), Department of Medicine, Cheng Hsin General Hospital; Faculty of Medicine, School of Medicine (H-HH, YC, Y-YC, C-PL, R-CL, G-YC, C-WS, Y-CY, H-CL, S-DL); Institute of Clinical Medicine and Genomic Research Center (H-HH, Y-HH, J-CW), National Yang-Ming University; Division of Chemoradiotherapy (YC), Department of Oncology Medicine; Division of Gastrointestinal Radiology (Y-YC), Department of Radiology; Division of Gastroenterology (C-PL, T-IH, Y-HH, C-WS, H-CL), Department of Medicine; Division of Pediatric Radiology (R-CL), Department of Radiology, Taipei Veterans General Hospital; Institute of Pharmacology (T-IH), School of Medicine, National Yang-Ming University; Division of General Surgery (G-YC), Department of Surgery; Department of Pathology and Laboratory Medicine (Y-CY); and Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan (J-CW).
authors.forename: Hung-Hsu
authors.initials: HH
authors.lastname: Hung
authors.forename: Yee
authors.initials: Y
authors.lastname: Chao
authors.forename: Yi-You
authors.initials: YY
authors.lastname: Chiou
authors.forename: Chung-Pin
authors.initials: CP
authors.lastname: Li
authors.forename: Rheun-Chuan
authors.initials: RC
authors.lastname: Lee
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.forename: Gar-Yang
authors.initials: GY
authors.lastname: Chau
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Su
authors.forename: Yi-Chen
authors.initials: YC
authors.lastname: Yeh
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
authors.forename: Jaw-Ching
authors.initials: JC
authors.lastname: Wu
mesh_terms: D000367:Age Factors; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008113:Liver Neoplasms / Q000401:mortality* / Q000628:therapy; D008297:Male; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D011379:Prognosis; D011517:Prothrombin Time; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin; D012720:Severity of Illness Index; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D012709:Serum Albumin; D000509:alpha-Fetoproteins; D001219:Aspartate Aminotransferases; D001663:Bilirubin