King's score as a novel prognostic model for patients with hepatitis B-associated hepatocellular carcinoma.
OBJECTIVE
King's score (KS) has been developed to predict the presence of cirrhosis and hepatocellular carcinoma (HCC) in patients with chronic liver diseases. We aimed to investigate the prognostic significance of the KS in hepatitis B-associated HCC.


METHODS
We retrospectively analyzed 319 hepatitis B-associated HCC patients. Preoperative data were collected to calculate the KS (age × aspartate aminotransferase × international normalized ratio/platelet count). The primary outcomes were overall survival (OS) and disease-free survival (DFS), which was estimated using the Kaplan-Meier method. Then, we carried out a multivariate Cox analysis to assess the independent significance of the KS. Additional analyses were carried out after patients were stratified on the basis of cirrhosis status and therapy methods to investigate the significance of KS in different subgroups.


RESULTS
During a median follow-up period of 44 months, 199 (62.4%) patients died and 144 (45.1%) experienced recurrence. The cut-off value for the KS was determined to be 33.31 with 56.8% sensitivity and 66.7% specificity. Compared with patients with low KS, the high group showed a higher probability of cirrhosis and worse Child-Pugh class (both P<0.05). Multivariate analysis identified older age, tumor size 5 or more, palliative therapy, high Barcelona Clinic Liver Cancer stage, and high KS as significant factors for predicting poor OS and DFS. A combination of the KS and tumor size showed better discrimination ability for survival than Barcelona Clinic Liver Cancer stage.


CONCLUSIONS
The KS is an effective index for predicting OS and DFS in hepatitis B-associated HCC. Larger cohorts are needed to validate our finding.
Department of Hepatobiliary Surgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, China.
Qing
Q
Pang
Jian-Bin
JB
Bi
Xin-Sen
XS
Xu
Su-Shun
SS
Liu
Jing-Yao
JY
Zhang
Yan-Yan
YY
Zhou
Kai
K
Qu
Chang
C
Liu
D000328:Adult; D000367:Age Factors; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000401:mortality / Q000473:pathology / Q000628:therapy / Q000821:virology; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000150:complications / Q000378:metabolism / Q000401:mortality; D006801:Humans; D019934:International Normalized Ratio; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications; D008113:Liver Neoplasms / Q000097:blood* / Q000401:mortality / Q000473:pathology* / Q000628:therapy / Q000821:virology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D010976:Platelet Count; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D015996:Survival Rate; D047368:Tumor Burden
D001219:Aspartate Aminotransferases