Tournoux-Facon et al developed a score for predicting death in a patient with hepatocellular carcinoma. This can help to identify a patient who may experience poor survival. The authors are from multiple institutions in France.
Patient selection: advanced hepatocellular carcinoma (incurable) with performance status < 4
Outcome: overall survival
Parameters:
(1) size and number of tumors (from Milan criteria)
(2) portal vein obstruction on ultrasound
(3) metastases
(4) WHO/ECOG performance status
(5) jaundice
(6) ascites
(7) serum alpha-fetoprotein concentration in ng/mL (µg/L)
(8) serum alkaline phosphatase concentration as a multiple of the upper limit of normal (ULN)
Parameters
Findings
Points
size and number of tumors
small (1 nodule < 5 cm; 2 or 3 with largest < 3 cm)
0
not small
1
portal vein obstruction
no
0
yes
1
metastases
no
0
yes
1
performance status
0
0
1
1
2 to 3
2
jaundice
no
0
yes
1
ascites
no
0
yes
1
serum alpha-fetoprotein
<= 200 ng/mL
0
> 200 ng/mL
1
serum alkaline phosphatase
<= 2 * ULN
0
> 2 * ULN
2
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10 (paper says 11, probably when 1 for performance status included)
• The higher the score the worse the prognosis for the patient.
Score
Risk Group
50% Survival
0 to 3
low
9 to 11 months
4 to 6
intermediate
4 to 6 months
7 to 10
high
2 months
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