Toyoda et al reported the BALAD score for staging a patient with hepatocellular carcinoma. This correlates with outcome. The authors are from Ogaki Municipal Hospital and Kinki University in Japan
Patient selection: hepatocellular carcinoma (HCC)
Parameters:
(1) B: serum total bilirubin in mg/dL
(2) A: serum albumin in g/L
(3) L: Lens culinaris agglutinin-reactive alpha-fetoprotein (AFP-L3) in percent
(4) A: alpha-fetoprotein (AFP) in ng/mL
(5) D: des-gamma-carboxy prothrombin (DCP) in milliarbitrary units per mL (mAU/mL)
|
Parameters
|
Findings
|
Points
|
|
serum total bilirubin
|
< 1.0 mg/dL
|
0
|
|
|
1.0 to 2.0 mg/dL
|
1
|
|
|
> 2.0 mg/dL
|
2
|
|
serum albumin
|
> 3.5 g/dL
|
0
|
|
|
2.8 to 3.5 g/dL
|
1
|
|
|
< 2.8 g/dL
|
2
|
|
AFP-L3
|
< 15%
|
0
|
|
|
>= 15%
|
1
|
|
AFP
|
< 400 ng/mL
|
0
|
|
|
>= 400 ng/mL
|
1
|
|
DCP
|
< 100 mAU/mL
|
0
|
|
|
>= 100 mAU/mL
|
1
|
bilirubin-albumin score =
= (points for albumin) + (points for bilirubin)
number of serum markers above cutoffs =
= SUM(points all 3 markers)
|
Subscore
|
Finding
|
Points
|
|
bilirubin-albumin
|
0 or 1 (A)
|
0
|
|
|
2 or 3 (B)
|
1
|
|
|
4 (C)
|
2
|
|
number of positive markers
|
0
|
0
|
|
|
1
|
1
|
|
|
2
|
2
|
|
|
3
|
3
|
BALAD score =
= SUM(points for the 2 subscores)
Interpretation:
• minimum score: 0
• maximum score: 5
• The higher the score the worse the survival.
|
BALAD Score
|
5-Year Survival
|
Mean Survival
|
|
0
|
67%
|
76%
|
|
1
|
50%
|
47%
|
|
2
|
40%
|
47%
|
|
3
|
34%
|
35%
|
|
4
|
0%
|
21%
|
|
5
|
NA
|
12%
|
