Prognostic Score of Pawlik et al for Predicting Survival After Resection of a Large Hepatocellular Carcinoma

 

Parameters:

(1) serum alpha-fetoprotein (AFP) in ng/mL

(2) major vascular invasion (gross invasion of the right or left main branches of the hepatic or portal veins)

(3) number of hepatic tumor nodules

(4) degree of hepatic fibrosis (graded 0 to 6 using the scheme of Ishak et al, with complete bridging fibrosis grade 5 and cirrhosis grade 6)

Parameter	Finding	Points
serum AFP	< 1,000 ng/mL	0
	>= 1,000 ng/mL	1
major vascular invasion	absent	0
	present	1
number of tumor nodules	1	0
	>= 2	1
hepatic fibrosis	complete bridges or cirrhosis absent	0
	complete bridges or cirrhosis present (Ishak grade 5 or 6)	1

 

total number of risk factors =

= SUM(points for all 4 parameters)

 

Interpretation:

• minimum total score: 0

• maximum total score: 4

• The higher the score the worse the survival.

 

Number of Risk Factors	Prognostic Score	Median Survival
0	1	60 months
1 or 2	2	19 months
3 or 4	3	10 months

 

After 6 years the survival curves for prognostic scores 2 and 3 become similar with survival at 10 years about 10%.

 

Performance:

• Survival based on T classification showed 3 groups (T1, T2, T3-4) which stratified survival better (Figure 5, page 454) with T1 good (median survival 60 months), T2 fair and T3-T4 poor.

• The prognostic score should not be used to exclude patients from surgical resection since some patients have a more favorable T stage.

 

Limitations:

• The method and normal reference range for serum AFP was not given.