Kitai et al modified the Japanese Integrated Staging (JIS) score for patients with hepatocellular carcinoma with the addition of biomarker data. This can help to distinguish patients with a different prognosis. The authors are from Kinki University and the Osaka Red Cross Hospital in Japan.
Patient selection: hepatocellular carcinoma
Parameters:
(1) Child-Pugh stage (A, B or C)
(2) TNM stage by the LCSGJ (Liver Cancer Study Group of Japan)
(3) number of tumor biomarkers (AFP, AFP-L3, DCP)
Tumor biomarkers (shared with the BALAD score):
(1) Lens culinaris agglutinin-reactive alpha-fetoprotein (AFP-L3) in percent
(2) alpha-fetoprotein (AFP) in ng/mL
(3) des-gamma-carboxy prothrombin (DCP) in milliarbitrary units per mL (mAU/mL)
Tumor Marker
|
Findings
|
Points
|
AFP-L3
|
< 15%
|
0
|
|
>= 15%
|
1
|
AFP
|
< 400 ng/mL
|
0
|
|
>= 400 ng/mL
|
1
|
DCP
|
< 100 mAU/mL
|
0
|
|
>= 100 mAU/mL
|
1
|
number of positive tumor markers =
= SUM(points for all 3 biomarkers)
Parameter
|
Finding
|
Points
|
Child-Pugh score
|
A
|
0
|
|
B
|
1
|
|
C
|
2
|
TNM stage
|
I
|
0
|
|
II
|
1
|
|
III
|
2
|
|
IV
|
3
|
tumor biomarkers
|
0
|
0
|
|
1
|
1
|
|
2 or 3
|
2
|
total score =
= SUM(points for the 2 parameters)
Interpretation:
• minimum score: 0
• maximum score: 7
• The higher the score the worse the survival.
c-JIS
|
Mean Survival (Kitai 2008)
|
0
|
89 months
|
1
|
61 months
|
2
|
55 months
|
3
|
50 months
|
4
|
31 months
|
5
|
15 months
|
6
|
8 months
|
7
|
5 months
|