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Keywords:

  • Child–Turcotte–Pugh;
  • Cancer of Liver Italian Program;
  • hepatocellular carcinoma;
  • Japan Integrated Scoring;
  • cirrhosis;
  • Model for End-Stage Liver Disease

Abstract

BACKGROUND

The Japan Integrated Scoring (JIS) system was revealed as a better model for outcome prediction compared with the Cancer of Liver Italian Program system for hepatocellular carcinoma (HCC), and the Model for End-Stage Liver Disease (MELD) was better as a prognostic predictor for patients with cirrhosis compared with the Child–Turcotte–Pugh (CTP) system, which is a parameter used in the JIS system. The objective of the current study was to investigate the performance of the modified MELD-based JIS system.

METHODS

In the modified JIS system, the CTP class in the original JIS was replaced with MELD cut-off scores of <10, 10 to 14, and >14. The modified JIS system was compared with the original system in 276 patients with HCC who underwent locoregional therapy (transarterial chemoembolization or percutaneous injection).

RESULTS

The mean ± standard error original JIS score was 1.8 ± 1.0 (range, 0-4), compared with 2.0 ± 1.1 (range, 0-5) for the modified JIS system (P<.001). Using mortality as the endpoint, the area under receiver operating characteristic curve (AUC) for the modified JIS system was 0.804 compared with 0.741 for the original JIS system (P = .008) at 12 months, and the AUC was 0.853 and 0.765, respectively (P<.001), at 24 months. Survival analysis showed that the modified JIS system had a better discriminatory ability for patients in different score groups and was more accurate for outcome prediction in the Cox multivariate model.

CONCLUSIONS

The current results indicated that the MELD-based, modified JIS system has improved predictive ability compared with the original system and is a more feasible model for clinical staging in patients with HCC who are undergoing locoregional therapy. Cancer 2006. © 2006 American Cancer Society.