Abstract
Background and AimA model to estimate survival in ambulatory hepatocellular carcinoma patients (MESIAH) is useful for estimating patient prognosis but needs improvement for Korean patients, most of whom have a hepatitis B virus. We aimed to modify the MESIAH for better prognostication through enhancing calibration for Korean patient population (K-MESIAH).MethodsUtilizing a cohort of 1,969 hepatocellular carcinoma (HCC) patients from the National Cancer Center of Korea between 2004 and 2009, a survival prediction model was developed using the Cox proportional hazards model. The model’s performance was evaluated using C-statistical and χ2-statistical analyses. External validation was performed using an independent cohort of 328 patients from the Seoul National University Bundang Hospital.ResultsTo develop the K-MESIAH, etiology was added to the original risk factors (age, Model for Endstage Liver Disease, albumin, size of the largest nodule, number of tumor nodules, vascular invasion, metastasis, and alpha fetoprotein) in the MESIAH. From the internal validation study, the C-statistics and χ2-statistics for one-, three-, and five-years of survival were 0.83 (95% Confidence Interval: 0.82−0.85), 49.07; 0.81 (95% Confidence Interval: 0.79−0.82), 28.95; and 0.80 (95% Confidence Interval: 0.79−0.81), 20.93, respectively. The K-MESIAH also showed a high prediction ability for the external validation cohort.ConclusionsA survival prediction model for Korean HCC patients was developed and validated to have a high level of performance. This K-MESIAH may be more useful in clinical practice and personalized care in a hepatitis B virus endemic area.
Highlights
An accurate staging system is necessary to predict the prognosis of patients with cancer and to guide the therapeutic approach.[1]
To develop the K-MESIAH, etiology was added to the original risk factors in the MESIAH
A survival prediction model for Korean hepatocellular carcinoma (HCC) patients was developed and validated to have a high level of performance. This K-MESIAH may be more useful in clinical practice and personalized care in a hepatitis B virus endemic area
Summary
An accurate staging system is necessary to predict the prognosis of patients with cancer and to guide the therapeutic approach.[1]. A model to estimate survival in ambulatory HCC patients (MESIAH)[6] was proposed based on two cohorts, one from the Mayo Clinic in Rochester, United States (derivation cohort) and the other from the National Cancer Center, Korea (validation cohort).[7] This MESIAH uses the Model for End-Stage Liver Disease (MELD) score[8] to gauge liver dysfunction and includes objective and reproducible clinical parameters and tumor characteristics. Compared with other scoring systems, the MESIAH provides a wide range of scores to allow stratification of HCC patients with significantly different prognoses to provide survival probabilities, which is useful in clinical practice.[6]. A model to estimate survival in ambulatory hepatocellular carcinoma patients (MESIAH) is useful for estimating patient prognosis but needs improvement for Korean patients, most of whom have a hepatitis B virus. We aimed to modify the MESIAH for better prognostication through enhancing calibration for Korean patient population (K-MESIAH)
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