Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Internal Medicine, University of Nevada School of Medicine, Reno, NV, USA.
Eur J Cancer. 2016 Aug;63:25-33. doi: 10.1016/j.ejca.2016.04.023. Epub 2016 May 31.
The survival of hepatocellular carcinoma (HCC) patients is heterogeneous. We aim to develop and validate a simple prognostic model to estimate survival for HCC patients (MESH score).
A total of 3182 patients were randomised into derivation and validation cohort. Multivariate analysis was used to identify independent predictors of survival in the derivation cohort. The validation cohort was employed to examine the prognostic capabilities.
The MESH score allocated 1 point for each of the following parameters: large tumour (beyond Milan criteria), presence of vascular invasion or metastasis, Child-Turcotte-Pugh score ≥6, performance status ≥2, serum alpha-fetoprotein level ≥20 ng/ml, and serum alkaline phosphatase ≥200 IU/L, with a maximal of 6 points. In the validation cohort, significant survival differences were found across all MESH scores from 0 to 6 (all p < 0.01). The MESH system was associated with the highest homogeneity and lowest corrected Akaike information criterion compared with Barcelona Clínic Liver Cancer, Hong Kong Liver Cancer (HKLC), Cancer of the Liver Italian Program, Taipei Integrated Scoring and model to estimate survival in ambulatory HCC Patients systems. The prognostic accuracy of the MESH scores remained constant in patients with hepatitis B- or hepatitis C-related HCC. The MESH score can also discriminate survival for patients from early to advanced stages of HCC.
This newly proposed simple and accurate survival model provides enhanced prognostic accuracy for HCC. The MESH system is a useful supplement to the BCLC and HKLC classification schemes in refining treatment strategies.
肝细胞癌（HCC）患者的生存率存在异质性。我们旨在开发和验证一种简单的预后模型，以估计 HCC 患者的生存率（MESH 评分）。
将 3182 名患者随机分为推导队列和验证队列。在推导队列中，使用多变量分析确定生存的独立预测因素。验证队列用于检验预后能力。
MESH 评分对以下参数各分配 1 分：肿瘤较大（超出米兰标准）、存在血管侵犯或转移、Child-Turcotte-Pugh 评分≥6、体能状态≥2、血清甲胎蛋白水平≥20ng/ml 和血清碱性磷酸酶≥200IU/L，最高得分为 6 分。在验证队列中，所有 MESH 评分（0 至 6 分）之间的生存差异均有统计学意义（均 p<0.01）。与巴塞罗那临床肝癌、香港肝癌（HKLC）、意大利肝癌计划、台北综合评分和门诊 HCC 患者生存模型评估系统相比，MESH 系统具有最高的同质性和最低的校正 Akaike 信息准则。MESH 评分在乙型肝炎或丙型肝炎相关 HCC 患者中的预后准确性保持不变。MESH 评分还可以区分 HCC 早期和晚期患者的生存情况。
本研究提出的新的简单而准确的生存模型为 HCC 提供了增强的预后准确性。MESH 系统是 BCLC 和 HKLC 分类方案的有用补充，可以完善治疗策略。
