Survival of patients with hepatocellular carcinoma is determined by the extent of the tumor and the underlying liver function.
Dr Ray Kim and colleagues from Minnesota, USA developed a survival model for hepatocellular carcinoma based on objective parameters including the Model for Endstage Liver Disease (MELD) as a gauge of liver dysfunction.
The team evaluated 477 patients with hepatocellular carcinoma seen at Mayo Clinic Rochester between 1994 and 2008, and 904 patients at the Korean National Cancer Center between 2000 and 2003.
Multivariate proportional hazards models and corresponding risk score were created based on baseline demographic, clinical, and tumor characteristics.
|The majority of patients had viral hepatitis as the underlying liver disease|
The researchers performed internal and external validation of the model.
Discrimination and calibration of this new model were compared against existing models including Barcelona Clinic Liver Cancer (BCLC), Cancer of the Liver Italian Program (CLIP), and Japan Integrated Staging (JIS) scores.
The team found that the majority of the patients had viral hepatitis as the underlying liver disease.
The survival model incorporated MELD, age, number of tumor nodules, size of the largest nodule, vascular invasion, metastasis, serum albumin, and alpha-fetoprotein.
The researchers found that the coefficients remained largely unchanged between iterations on cross-examination.
Observed survival in the validation cohort matched closely with what was predicted by the model.
The team observed that concordance (c)-statistic for this model was superior to that for BCLC, CLIP, or JIS.
Dr Kim's team concluded, "The score was able to further classify patient survival within each stage of the BCLC classification."
"A new model to predict survival of hepatocellular carcinoma patients based on objective parameters provides refined prognostication and supplements the BCLC classification."