People diagnosed with liver cancer often want to know their prognosis during treatment. And doctors make those estimations using very precise scoring systems that use certain health measures as a basis. One of the first was known as the Child-Turcotte-Pugh score. Other prognostic models such as the Model for End-Stage Liver Disease (MELD) and Short-and Long-Term Prognostic Indices (STPI and LTPI) have also been developed.1
The Child-Turcotte-Pugh (CTP) score is widely used by both physicians and medical researchers to make definitive distinctions between compensated and decompensated cirrhosis. Because of its ease of use, the CTP score was ultimately recognized as a tool for determining a patient's eligibility for a liver transplant. The CTP classification uses five variables—hepatic encephalopathy, ascites, bilirubin level, level of albumin and prothrombin time—a type of blood clotting measurement—as parameters. Each are assigned a number that, in succession, describes its severity.2
Liver Disease Measure Evaluated
Now, a new study is showcasing a different method that researchers claim can be accurately used to predict a patient's prognosis during treatment for hepatocellular carcinoma.3 "Recently, two new prognostic scoring systems—the CLIP score, developed by Italian investigators and the BCLC score, developed in Barcelona—have been widely used to assess prognosis in patients presenting with hepatocellular carcinoma," wrote doctors in the department of Gastroenterology at the University of Tokyo. "[However], each system has its own relative limitations."
The Tokyo Score, the study team stressed, offers an improved way of measuring prognosis. "We thought it necessary to create a new scoring system that provides more precise prediction of early hepatocellular carcinoma," explained Ryosuke Tateishi, MD, in the department of Gastroenterology at the University of Tokyo, who participated in the study.
The Japanese researchers tested the Tokyo score in a group of 403 patients who had been diagnosed with liver cancer and treated with percutaneous ablation versus 203 patients with liver cancer who underwent hepatectomy, a surgical procedure performed to remove cancerous liver tissue. The Tokyo score uses levels of albumin in the blood and bilirubin, as well as size and number of liver tumors to assess a patient's prognosis.
Study: Tokyo Score Corresponds to Survival Odds
The scientists found that five-year survival rates fell significantly with incremental increases in the Tokyo score. Those with a score of zero had a 5-year survival estimate of about 79%, but those with scores ranging from 4 to 6 faced survival odds of about 14% over 5 years, the researchers reported.
In comparing the Tokyo score with the BCLC and CLIP scoring systems, the Tokyo score proved to be equal to CLIP and better than BCLC staging, the researchers said. The Tokyo score, overall, also seemed to be more informative than the other two, wrote the research team.
In conclusion, the researchers stated that the Tokyo score may be "useful" in predicting the prognosis of patients with hepatocellular carcinoma and who may be candidates for either hepatectomy or percutaneous ablation. (The latter uses substances like alcohol to kill cancer tumors).4
Study Results May Not be Reproducible
In an editorial accompanying the study,5 Dr. Stephen Ryder at Queen's Medical Centre Nottingham in England wrote that it's important to note that the models used in this study are not based on a patient's "natural history" of liver cancer. "Almost all patients had therapy, and some patients had more than one treatment [approach]," Ryder emphasized.
Thus, the outcome of these models is significantly affected by the impact of the treatments used in these patients, and as such, the same outcomes may not be able to be reproduced in a typical clinical setting.
Tateishi concurs with that perspective. "It is true that treatment-related factors influence the prognosis," he said. "For example, percutaneous ethanol injection is less effective to patients with a greater than 5 centimeter hepatocellular carcinoma."
Despite that, 20 thousand patients included in the Liver Cancer Study Group of Japan, a large analysis of liver cancer in that country who had undergone surgery for their cancer, showed that the larger a tumor is, the worse a patient's prognosis, regardless of the treatment used, Tateishi pointed out. "I think we can improve the prognosis of hepatocellular carcinoma patients by percutaneous treatment or resection, but cannot change the clinical course drastically," he said. "Thus we believe the Tokyo Score is suitable for 'not advanced' patients, except for those who receive liver transplantation."
The bottom line, he said, is that "we think simplicity is very important in the staging system for daily practice."
1. Lee DH, Son JH, Kim TW. New scoring systems for severity outcome of liver cirrhosis and hepatocellular carcinoma: current issues concerning the Child-Turcotte-Pugh score and the Model of End-Stage Liver Disease (MELD) score. [Translated from Korean]. Taehan Kan Hakhoe Chi 2003 Sep;9(3):167-79.
2. Talwalkar JA, Kim WR, Rosen CB, Kamath PS, Wiesner RH. Effect of minimal listing criteria on waiting list registration for liver transplantation: a process-outcome analysis. Mayo Clin Proc 2003 Apr;78(4):431-5.
3. Tateishi R, Yoshida H, Shiina S et al. Proposal of a new prognostic model for hepatocellular carcinoma: an analysis of 403 patients. Gut 2005 Mar;54(3):419-25.
4. Society of Interventional Radiology. Treatments. Tumor Ablation. Available at: http://www.sirweb.org/patPub/cancerTreatments.shtml. Accessed March 11, 2005.
5. Ryder S. Predicting survival in early hepatocellular carcinoma. Gut 2005 Mar;54(3):328-9.
John Martin is a long-time health journalist and an editor for Priority Healthcare. His credits include coverage of health news for the website of Fox Television's The Health Network, and articles for the New York Post and other consumer and trade publications.
