Model of End Stage Liver Disease Score and Hepatocellular Carcinoma

Abstract

BACKGROUND: Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy worldwide (1). It is the first cause of cancer mortality in Egypt (2) due to the heavy burden of chronic HCV (14.7%). Among cir-rhotic patients, 1–4% per year will develop of HCC (3). HCC patients evaluated for liver transplantation are often given exceptional MELD score, giving them a priority for liver transplantation. We aimed at determining the MELD score in HCC patients, its correlation with TNM tumour stage and tumour size. Also, we aimed at determining a cut off value of MELD score above which chronic HCV (CHC) cirrhotic patients having high chance to develop HCC. MATERIALS AND METHODS: The study included 98 patients with CHC and HCC (group I) and 219 patients with CHC without HCC (group II). CHC was diagnosed by ELISA for HCV Antibody and serum HCV RNA .HCC diag-nosis was based on EASL criteria i.e. focal hepatic lesion with arterial phase enhancement and washout in portal and delayed phases, obtained by contrast enhanced abdom-inal CT and or MRI. HCC was staged according to the sev-enth edition TNM tumour staging system. MELD score was calculated using the following formula MELD score = 10 * ((0.957*ln (Creatinine)) + (0.378*ln(Bilirubin)) + (1.12*ln (INR))) + 6.43.We used the MELD score calculator of the iLiver application of the EASL. We computed ROC curve for MELD score concerning the prediction of HCC. Stratum specific likelihood ratio (SSLR) was calculated as the pro-portion of diseased subjects (HCC) with a test result in a given range divided by the proportion of non-diseased sub-jects (non HCC) with a test result in the same range (4). RESULTS: MELD score was significantly higher in group I than group II. The score was 9.71 AE 4.08 in group I ver-sus 5.61 AE 3.25 in group II (p ≤ 000). In group I the MELD score ranged from 0.7 to 20.33. There was signifi-cant positive correlation between MELD score and TNM tumour stage (r = 0.312, p = 0.002) but the correlation was insignificant as regards the tumour size (r = 0.041, p = 0.687). The distribution of TNM tumour stage in group I was as follows: stage I represented 19.3%, stage II represented 25.5%, stage IIIa represented 19.3%, stage IIIb represented 18.3%, stage IIIc represented 1%, stage IVa represented 8% and stage IVb represented 7%. The cut off value of MELD score above which there was a high risk of HCC development was ≥5.74. The area under the curve (AUC) was 78.3%, sensitivity was 87.8%, specificity was 56%, positive predictive value (PPV) of 46.7%, negative predictive value (NPV) of 91%, accuracy of 65.3% and pos-itive likelihood ratio (LR) of 1.96. The SSLR for HCC pres-ence by MELD score was 0.21 in score <5, 0.97 in score from 5 to 10 and 4.57 in score >10. CONCLUSION: MELD score has significant positive correla-tion with TNM tumour stage in HCC cases. CHC patients with MELD score >10 have SSLR for HCC presence of 4.57 and are in need for closer follow up. REFERENCES: 1. Saar B, Kellner F. Radiological Diagnosis of Hepatocellular Carcinoma. Liver International 2008;28:189–199. 2. Anwar WA, Khaled HM, Amra HA, et al. Changing pattern of hepatocellular carcinoma (HCC) and its risk fac-tors in Egypt: Possibilities for prevention. 3. Egyptian national control strategy for viral hepatitis, 2008–2012 Arab Republic of Egypt, Ministry of Health and Population, National Committee for the Control of Viral Hepatitis. 4. Peirce JC, Cornell RG. Integrating stratum-specific likelihood ratios with the analysis of ROC curves. Med Decis Making1993;13:141–151