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

作者：Huo Teh Ia^*; Hsia Cheng Yuan; Huang Yi Hsiang; Lin Han Chieh; Lee Pui Ching; Lui Wing Yiu; Chiang Jen Huei; Chiou Yi You; Loong Che Chuan; Lee Shou Dong

来源：Journal of Clinical Gastroenterology, 2009, 43(8): 773-781.

• BCLC
• CLIP
• hepatocellular carcinoma
• JIS
• MELD
• MELD-Na
• TNM
• Tokyo score

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.

• 出版日期2009-9