Selecting a short-term prognostic model for hepatocellular carcinoma: comparison between the model for end-stage liver disease (MELD), MELD-sodium, and five cancer staging systems.

Abstract

BACKGROUND:

The model for end-stage liver disease (MELD) and MELD-sodium (MELD-Na) are prognostic models for cirrhotic patients with or without hepatocellular carcinoma (HCC). This study compared the predictive accuracy between the MELD, MELD-Na, TNM (tumor, node, metastasis), Cancer of the Liver Italian Program (CLIP), Barcelona Clinic Liver Cancer (BCLC), Japan Integrated Scoring (JIS), and Tokyo score for 3-month and 6-month mortality in HCC patients.

METHODS:

A total of 953 patients were prospectively enrolled. The predictive accuracy was compared between different models using the area under receiver operating characteristic curve (AUC).

RESULTS:

The CLIP system had the highest AUC (0.875) for predicting 3-month mortality, followed by the Tokyo score (0.874), JIS (0.868), BCLC (0.855), MELD-Na (0.829), MELD (0.803), and finally, TNM (0.795) system. At 6 months, the top 3 models and their AUCs were the CLIP (0.882), Tokyo (0.861), and JIS (0.85). MELD-Na consistently had significantly better predictive accuracy than the MELD at 3 and 6 months. The MELD and MELD-Na were better prognostic models in predicting the mortality for surgical patients (AUC, 0.719 to 0.740), whereas the CLIP and Tokyo systems were the 2 better models in staging nonsurgical (AUC, 0.849 to 0.884) and high-risk patients (AUC, 0.790 to 0.846), defined as having at least 2 independent risk factors of mortality, at 3 and 6 months.

CONCLUSIONS:

The MELD-Na may improve the prognostic ability of the MELD system for patients with HCC. Both the CLIP and Tokyo systems are better short-term prognostic models. These findings are helpful in designing future clinical trials for HCC.

• Authors: Teh-Ia Huo, Cheng-Yuan Hsia, Yi-Hsiang Huang, Han-Chieh Lin, Pui-Ching Lee, Wing-Yiu Lui, Jen-Huei Chiang, Yi-You Chiou, Che-Chuan Loong, Shou-Dong Lee
• Journal: Journal of clinical gastroenterology (J Clin Gastroenterol) Vol. 43 Issue 8 Pg. 773-81 (Sep 2009) ISSN: 1539-2031 [Electronic] United States
• PMID: 19262404 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Area Under Curve
• Carcinoma, Hepatocellular (complications, mortality, pathology)
• Humans
• Kidney Failure, Chronic (mortality)
• Liver Cirrhosis (complications)
• Liver Neoplasms (complications, mortality, pathology)
• Models, Statistical
• Neoplasm Staging (methods)
• Prognosis
• ROC Curve
• Survival Analysis
• Survival Rate