title: The Kings Score refines prognostic prediction in hepatocellular carcinoma: a novel application.
abstract: OBJECTIVE
  There are a number of prognostic scores in hepatocellular carcinoma (HCC), none of which is optimal in predicting overall survival (OS) in the individual patient, particularly in intermediate stage disease, where patients are not surgically treatable but may qualify for a wide range of palliative interventions. We evaluated the prognostic role of a biochemical algorithm, the Kings Score (KS), in the palliative setting of care.
  
  
  METHODS
  We used the algorithm [age x AST x INR]/platelet count to derive the KS. Full clinical data including Barcelona Clinic Liver Cancer (BCLC) stage were studied in a training set of 97 patients from the UK. Independent predictors of survival identified in multivariate analysis were validated in an independent cohort of 766 patients from Japan and Italy.
  
  
  RESULTS
  In both training and validation sets, KS was confirmed as an independent predictor of OS (P < 0.01). Ad-hoc subgroup analysis revealed the KS to be prognostic in the palliative setting, being able to subclassify patients presenting with intermediate and advanced disease according to BCLC criteria (P < 0.001).
  
  
  CONCLUSIONS
  The KS integrates into the BCLC system to improve prognostic substratification in the palliative setting of care. The KS may help reducing disease heterogeneity and refine treatment allocation in intermediate-advanced HCC.
authors.affiliation: Division of Experimental Medicine, Imperial College London, Hammersmith Hospital, London, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Pinato
authors.affiliation: Division of Experimental Medicine, Imperial College London, Hammersmith Hospital, London, UK.
authors.forename: Georgios
authors.initials: G
authors.lastname: Karamanakos
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Ishizuka
authors.affiliation: Department of Translational Medicine, Università degli Studi del Piemonte Orientale "A. Avogadro", Novara, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Smirne
authors.affiliation: Department of Translational Medicine, Università degli Studi del Piemonte Orientale "A. Avogadro", Novara, Italy.|Interdisciplinary Research Center of Autoimmune Diseases, Università degli Studi del Piemonte Orientale "A. Avogadro", Novara, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Pirisi
authors.affiliation: Department of Gastroenterological Surgery, Dokkyo Medical University, Mibu, Tochigi, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Kubota
authors.affiliation: Division of Experimental Medicine, Imperial College London, Hammersmith Hospital, London, UK.
authors.forename: Rohini
authors.initials: R
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D007558:Italy; D007564:Japan; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging / Q000379:methods*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Kings Score; aspartate aminotransferase; hepatocellular carcinoma; international normalized ratio; platelet count; prognosis