Some patients with hepatocellular carcinoma may show a long term benefit after liver transplantation, while others have tumor recurrence with death. Iwatsuki et al developed a prognostic score to help grade patients with hepatocellular carcinoma. This grade correlated with tumor free survival while the TNM stage did not. The authors are from the University of Pittsburgh.
Variables used for prognostic score:
(1) number of lobes involved
(2) size of the tumor
(3) vascular invasion
Additional findings:
(4) surgical margin
(5) metastasis to lymph node(s)
(6) distant metastasis
|
Variable |
Finding |
Relative Risk |
95% Confidence Interval |
Points |
|
number of lobes involved |
bilobar |
3.1 |
1.7 – 5.4 |
3.1 |
|
|
unilobar |
1.0 (reference) |
|
0 |
|
size of tumor |
> 5 cm |
6.7 |
2.2 – 19.9 |
6.7 |
|
|
2 – 5 cm |
4.5 |
1.5 – 13.0 |
4.5 |
|
|
< 2 cm |
1.0 (reference) |
|
0 |
|
vascular invasion |
macroscopic |
15.0 |
6.7 – 33.8 |
15.0 |
|
|
microscopic |
4.4 |
2.1 – 9.5 |
4.4 |
|
|
absent |
1.0 (reference) |
|
0 |
after Table 2, page 392.
risk score =
= SUM(points for variable findings present)
Interpretation:
• minimum score: 0 (only reference findings present; no risk factors)
• maximum score: 24.8
|
Risk Score |
Grade |
50% Survival in Months |
% 5 Year Tumor Free Survival |
|
< 7.5 |
1 |
> 120 |
100% |
|
7.5 – 11.0 |
2 |
> 120 |
61% |
|
11.1 – 14.9 |
3 |
30 |
40% |
|
>= 15.0 |
4 |
12 |
5% |
|
positive margins, metastasis to lymph node, or distant metastasis |
5 |
6 |
0% |
|
Grade |
Transplant Liver? |
Adjuvant Chemotherapy? |
|
1 |
Yes |
No |
|
2 |
Yes |
no significant effect on tumor recurrence |
|
3 |
maybe |
no significant effect on tumor recurrence |
|
4 |
No |
|
|
5 |
No |
|
Specialty: Hematology Oncology, Surgery, general, Gastroenterology
ICD-10: ,
