Huo Teh-Ia, Lin Han-Chieh, Huang Yi-Hsiang, Wu Jaw-Ching, Chiang Jen-Huei, Lee Pui-Ching, Lee Shou-Dong
Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Cancer. 2006 Jul 1;107(1):141-8. doi: 10.1002/cncr.21972.
The Japan Integrated Scoring (JIS) system was revealed as a better model for outcome prediction compared with the Cancer of Liver Italian Program system for hepatocellular carcinoma (HCC), and the Model for End-Stage Liver Disease (MELD) was better as a prognostic predictor for patients with cirrhosis compared with the Child-Turcotte-Pugh (CTP) system, which is a parameter used in the JIS system. The objective of the current study was to investigate the performance of the modified MELD-based JIS system.
In the modified JIS system, the CTP class in the original JIS was replaced with MELD cut-off scores of <10, 10 to 14, and >14. The modified JIS system was compared with the original system in 276 patients with HCC who underwent locoregional therapy (transarterial chemoembolization or percutaneous injection).
The mean +/- standard error original JIS score was 1.8 +/- 1.0 (range, 0-4), compared with 2.0 +/- 1.1 (range, 0-5) for the modified JIS system (P < .001). Using mortality as the endpoint, the area under receiver operating characteristic curve (AUC) for the modified JIS system was 0.804 compared with 0.741 for the original JIS system (P = .008) at 12 months, and the AUC was 0.853 and 0.765, respectively (P < .001), at 24 months. Survival analysis showed that the modified JIS system had a better discriminatory ability for patients in different score groups and was more accurate for outcome prediction in the Cox multivariate model.
The current results indicated that the MELD-based, modified JIS system has improved predictive ability compared with the original system and is a more feasible model for clinical staging in patients with HCC who are undergoing locoregional therapy.
与意大利肝癌计划系统相比，日本综合评分（JIS）系统被证明是肝细胞癌（HCC）预后预测的更好模型；与终末期肝病模型（MELD）相比，Child-Turcotte-Pugh（CTP）系统作为肝硬化患者的预后预测指标效果更佳，而CTP系统是JIS系统中使用的一个参数。本研究的目的是探讨基于MELD改良的JIS系统的性能。
在改良的JIS系统中，将原始JIS中的CTP分级替换为MELD临界值<10、10至14和>14。将改良的JIS系统与276例接受局部治疗（经动脉化疗栓塞或经皮注射）的HCC患者的原始系统进行比较。
原始JIS评分的平均值±标准误为1.8±1.0（范围0 - 4），改良JIS系统为2.0±1.1（范围0 - 5）（P <.001）。以死亡率为终点，改良JIS系统在12个月时的受试者操作特征曲线下面积（AUC）为0.804，原始JIS系统为0.741（P =.008）；在24个月时，AUC分别为0.853和0.765（P <.001）。生存分析表明，改良JIS系统对不同评分组患者具有更好的鉴别能力，在Cox多变量模型中对预后预测更准确。
目前的结果表明，基于MELD改良的JIS系统与原始系统相比具有更好的预测能力，是接受局部治疗的HCC患者临床分期更可行的模型。
