title: Comparison of five models for end-stage liver disease in predicting the survival rate of patients with advanced hepatocellular carcinoma.
abstract: Prognosis of patients with advanced hepatocellular carcinoma (HCC) is under expectation. Life expectancy more than 3 months is one inclusion criteria for molecular targeted drugs in clinical trials. The main purpose of this research is to compare Model for End-Stage Liver Disease (MELD) and four MELD-based prognostic models in predicting the survival rate of advanced HCC patients. One hundred eighty-three patients with advanced HCC who were not amendable to standard anti-tumor therapy were retrospectively analyzed. Data were collected to classify patients according to MELD, Model for End-Stage Liver Disease with the incorporation of serum sodium (MELD-NA), Model for End-Stage Liver Disease to ascites and sodium (MELD-AS), integrated Model for End-Stage Liver Disease (iMELD), and Model for End-Stage Liver Disease to sodium (MESO) scores at diagnosis. 1-, 3-, and 6-month survivals were the end points used in the analysis. When predicting 1-month survival, MELD-AS, MELD, and MESO were the top 3 ranking staging systems. When predicting 3-month survival, area under the receiver operating characteristic curve (AUC) of MELD-AS is significantly higher than that of the other models (P < 0.05). When predicting 6-month survival, AUCs of MELD-AS and MELD-NA are significantly higher than those of the other models (P < 0.05). Cutoff point of MELD-AS is 23.11 with 40.5 % sensitivity and 93.8 % specificity at 1 month, 9.5 with 76.9 % sensitivity and 59.5 % specificity at 3 months, and 18.5 with 27.0 % sensitivity and 89.1 % specificity at 6 months. MELD-based scores of death group are significantly higher than those of survivors within 1 and 3 months (P < 0.001). Independent prognostic factors identified by multivariate analysis included persistent ascites, serum sodium, and thrombosis. MELD-AS is the best model in the prediction of short and intermediate survival among the five models for end-stage liver disease analyzed for Chinese advanced HCC patients.
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China.
authors.forename: Ying-Fen
authors.initials: YF
authors.lastname: Hong
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China. sumszhanhong@163.com.
authors.forename: Zhan-Hong
authors.initials: ZH
authors.lastname: Chen
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China.
authors.forename: Xiao-Kun
authors.initials: XK
authors.lastname: Ma
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China.
authors.forename: Xing
authors.initials: X
authors.lastname: Li
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China.
authors.forename: Dong-Hao
authors.initials: DH
authors.lastname: Wu
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China.
authors.forename: Jie
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China.
authors.forename: Min
authors.initials: M
authors.lastname: Dong
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China.
authors.forename: Li
authors.initials: L
authors.lastname: Wei
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China.
authors.forename: Tian-Tian
authors.initials: TT
authors.lastname: Wang
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China.
authors.forename: Dan-Yun
authors.initials: DY
authors.lastname: Ruan
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China.
authors.forename: Ze-Xiao
authors.initials: ZX
authors.lastname: Lin
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China.
authors.forename: Jing-Yun
authors.initials: JY
authors.lastname: Wen
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China.
authors.forename: Qu
authors.initials: Q
authors.lastname: Lin
authors.affiliation: Cell-gene Therapy Translational Medicine Research Center, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China.
authors.forename: Chang-Chang
authors.initials: CC
authors.lastname: Jia
authors.affiliation: Department of Medical Oncology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, People's Republic of China. wuxiangy@mail.sysu.edu.cn.
authors.forename: Xiang-Yuan
authors.initials: XY
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000453:epidemiology / Q000473:pathology*; D058625:End Stage Liver Disease / Q000097:blood / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000453:epidemiology / Q000473:pathology*; D008113:Liver Neoplasms / Q000097:blood / Q000453:epidemiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012720:Severity of Illness Index; D012964:Sodium / Q000097:blood; D016019:Survival Analysis
chemical_list: D012964:Sodium
keywords: Hepatocellular carcinoma; MELD; MELD-based prognostic models; Prognosis; Standard anti-tumor therapy; Survival time