Yau et al reported the Advanced Liver Cancer Prognostic System (ALCPS) for evaluating a patient with advanced hepatocellular carcinoma. These can help to identify a patient who may require more aggressive management. The authors are from the University of Hong Kong and Queen Mary Hospital in Hong Kong.
Patient: adult (>- 18 years of age) with advanced hepatocellular carcinoma
Parameters:
(1) ascites
(2) abdominal pain
(3) weight loss
(4) Child-Pugh grade (A, B, C)
(5) alkaline phosphatase IU/L
(6) serum total bilirubin in µmol/L
(7) urea in mmol/L
(8) portal vein thrombosis
(9) tumor size
(10) lung metastases
(11) serum alpha-fetoprotein (AFP) in ng/mL
|
Parameter |
Finding |
Points |
|
ascites |
no |
0 |
|
|
yes |
2 |
|
abdominal pain |
no |
0 |
|
|
yes |
2 |
|
weight loss |
no |
0 |
|
|
yes |
2 |
|
Child-Pugh grade |
A |
0 |
|
|
B |
2 |
|
|
C |
5 |
|
alkaline phosphatase |
<= 200 |
0 |
|
|
> 200 IU/L |
3 |
|
serum total bilirubin |
<= 33 |
0 |
|
|
33.01 to 50 |
1 |
|
|
> 50 µmol/L |
3 |
|
urea |
<= 8.9 |
0 |
|
|
> 8.9 |
2 |
|
portal vein thrombosis |
no |
0 |
|
|
yes |
3 |
|
tumor size |
<= 5 cm |
0 |
|
|
> 5 cm |
3 |
|
|
diffuse |
4 |
|
lung metastases |
no |
0 |
|
|
yes |
3 |
|
AFP |
<= 400 ng/mL |
0 |
|
|
> 400 ng/mL |
4 |
where:
• The points for Child-Pugh grade A in the original paper is 5 and for grade C is 0.
total score =
= SUM(points for all 11 parameters)
Interpretation:
• minimum score: 0
• maximum score: 33
• The higher the score the lower the 3-month survival rate.
|
Total Score |
Prognosis |
3-Month Survival Rate |
|
<= 2 |
good |
> 81% |
|
3 to 6 |
good |
72 to 80% |
|
7 or 8 |
good |
66 to 69% |
|
9 |
intermediate |
63% |
|
10 to 12 |
intermediate |
39 to 51% |
|
13 or 14 |
intermediate |
42 to 47% |
|
15 |
intermediate |
38% |
|
16 |
poor |
33% |
|
17 to 19 |
poor |
21 to 29% |
|
20 to 22 |
poor |
10 to 17% |
|
>= 23 |
poor |
< 10% |
Specialty: Hematology Oncology, Gastroenterology
