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Evaluation of Model for End Stage Liver Disease (MELD)-based systems as prognostic index for hepatocellular carcinoma

Authors

  • Jenny L Limquiaco,

    1. Department of Medicine and Therapeutics and Institute of Digestive Disease, The Chinese University of Hong Kong,
    2. Department of Medicine, Division of Gastroenterology, University of the Philippines-Philippine General Hospital, Manila, Philippines
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  • Grace LH Wong,

    1. Department of Medicine and Therapeutics and Institute of Digestive Disease, The Chinese University of Hong Kong,
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  • Vincent WS Wong,

    1. Department of Medicine and Therapeutics and Institute of Digestive Disease, The Chinese University of Hong Kong,
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  • Paul BS Lai,

    1. Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China; and
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  • Henry LY Chan

    1. Department of Medicine and Therapeutics and Institute of Digestive Disease, The Chinese University of Hong Kong,
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  • Specific author contributions: Jenny L Limquiaco: Study design, data analysis, manuscript writing. Grace LH Wong and Vincent WS Wong: Patient follow-up, data analysis. Paul BS Lai: Patient follow-up. Henry LY Chan: Patient follow-up, study design, data analysis, manuscript writing.

  • Declaration of Conflict of Interest: Henry LY Chan is a member of the advisory board for Schering-Plough, Novartis Pharmaceutical and Bristol-Myers Squibb.

Professor Henry LY Chan, Department of Medicine and Therapeutics, 9/F Prince of Wales Hospital, 30–32 Ngan Shing Street, Shatin, Hong Kong, China. Email: hlychan@cuhk.edu.hk

Abstract

Background:  The Cancer of Liver Italian Program (CLIP) and Japan Integrated Scoring System (JIS) used the Child-Turcotte-Pugh (CTP) score to evaluate the liver function.

Aim:  We aimed to evaluate the performance of Model for End Stage Liver Disease (MELD) based CLIP and JIS to predict the prognosis of hepatocellular carcinoma (HCC).

Methods:  Consecutive patients with HCC who presented to our Hepatoma Clinic from January 2003 to April 2005 were studied. MELD-based CLIP and JIS were generated by replacing the original CTP score with MELD score at three categories (<10, 10–14 and >14).

Results:  Among 471 HCC patients (85.1% males; aged 58.8 ± 12.2 years), 73% had chronic hepatitis B, 37.4% had >1 nodule, 84.1% had tumor size >2 cm, 55.0% had Child's B cirrhosis, 12.7% underwent tumor resection and 20.6% received locoregional therapy. The cumulative survival at 3 and 6 months were 67% and 55%, respectively. For 3-month survival, the area under the receiver operating characteristic curves (AUC) of MELD-CLIP (0.69) and MELD-JIS (0.69) were superior to the original systems (0.64, P = 0.004 and 0.64, P = 0.0018, respectively). For 6-month survival, AUC of MELD-CLIP (0.64) and MELD-JIS (0.62) were also superior to the original systems (0.54, P = 0.003 and 0.59, P = 0.002, respectively). The MELD-based systems performed best among patients who received locoregional therapy to HCC. Advanced cirrhosis (hypoalbuminemia, hyperbilirubinemia, ascites, coagulopathy and elevated creatinine), and cancer (portal vein thrombosis, elevated alpha-fetoprotein, large and multiple tumors) were associated with higher mortality.

Conclusions:  MELD-based systems performed better than Child-Pugh based systems as prognostic indexes for HCC.

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