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Determination of the optimal model for end‐stage liver disease score in patients with small hepatocellular carcinoma undergoing loco‐regional therapy
Author(s) -
Huo TehIa,
Wu JawChing,
Lin HanChieh,
Lee FaYauh,
Hou MingChih,
Huang YiHsiang,
Lee PuiChing,
Chang FullYoung,
Lee ShouDong
Publication year - 2004
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.20310
Subject(s) - medicine , hepatocellular carcinoma , liver transplantation , model for end stage liver disease , liver disease , stage (stratigraphy) , milan criteria , oncology , gastroenterology , transplantation , paleontology , biology
The model for end‐stage liver disease (MELD) has been a prevailing system to prioritize cirrhotic patients awaiting liver transplantation. An “exceptional” MELD score of 20 and 24 points is assigned for stage T1 and T2 patients with small hepatocellular carcinoma (HCC), respectively. However, this strategy is based on scarce data and the optimal score for these patients remains uncertain. We investigated 238 patients with small HCC who were candidates for liver transplantation and underwent arterial chemoembolization or percutaneous injection therapy using acetic acid or ethanol. Tumor stage ( P = .001) and Child‐Turcotte‐Pugh (CTP) class ( P < .001) were independent risk factors predicting tumor progression or death in survival analysis. The risk of disease progression in HCC patients stratified by tumor stage was mapped and equated with the risk of mortality of 456 cirrhotic patients without HCC. The 6‐ and 12‐month rates of disease progression were 4% and 6%, respectively, for stage T1 HCC patients (n = 50; mean MELD: 9.5). These rates were close to and no higher than the mortality rate in MELD category 8–12 at the corresponding time period (7.1% and 11.3%, respectively; n = 141). For stage T2 patients (n = 188; mean MELD: 9.3), the corresponding rates were 5.3% and 13.8%, respectively, which were close to and no higher than the mortality rate in MELD category 10–14 (9.0% and 13.9%, respectively, n = 166). In conclusion, the risk of disease progression is quite low for selected HCC patients undergoing loco‐regional therapy. A lower MELD score may be suggested to be equivalent to the risk of short‐ and mid‐term mortality in the cirrhosis group. (Liver Transpl 2004;10:1507–1513.)