MELD score and AST-to-platelet ratio index predict long-term survival in patients with a small hepatocellular carcinoma following non-transplant therapies: a pilot study

Abstract

Aim Liver transplantation (LT) is the most effective treatment for long-term survival from hepatocellular carcinoma (HCC); however, insufficient donors limit therapy. We sought to identify characteristics that predicted long-term survival after non-transplant therapies in patients with small HCC. Methods In a database of 1,050 HCC patients, we identified those with single HCC ≤ 3.0 cm, who underwent hepatic resection (HR, n = 16), radiofrequency ablation (RFA, n = 55), or LT (n = 23) with 5-years follow-up. Survival and odds-ratios for survival (OS) after HR/RFA were calculated for MELD score, platelet count, creatinine, albumin, AST/Platelet Ratio Index (APRI), INR, and bilirubin. Results LT patients had 3 and 5-year OS of 82.6% and 73.9% compared to HR/RFA patients with 3 and 5-year OS of 40.8% and 33.8%. The strongest predictors of survival after HR/RFA were MELD < 10 (OR 4.43, 95% CI 1.85–10.58) and APRI ≤ 0.5 (OR 4.25, 95% CI 1.63–11.08). HR/RFA patients with both MELD < 10 and APRI ≤ 0.5 had 3- and 5-year OS of 77.3% and 72.7%. Conclusion Patients with MELD < 10 and APRI ≤ 0.5 who undergo HR/RFA have survival approaching LT. Perhaps patients who meet these criteria can safely undergo non-transplant therapy and donor livers can be allocated to patients with a greater need.

Secure intravariceal sclerotherapy with red dichromatic imaging decreases the recurrence rate of esophageal varices: A propensity score matching analysis

“…18 Sarkar et al reported that AST-to-platelet ratio index (APRI) was the strongest predictor of OS after radical surgery by liver transplantation or RFA for small HCC. 19 Thus, the previous reports showed that AST was an important predictor for OS. The reason why platelet count and albumin level were not extracted as the predictor by multivariate analysis in our study appears to be correlated with the relative short observation period.…”

“…Nishikawa et al showed that AST and Child‐Pugh score were predictors for OS in patients with HCC receiving sorafenib by multivariate analysis 18 . Sarkar et al reported that AST‐to‐platelet ratio index (APRI) was the strongest predictor of OS after radical surgery by liver transplantation or RFA for small HCC 19 . Thus, the previous reports showed that AST was an important predictor for OS.…”

Overexpression of miRNA-21 Promotes the Proliferation and Invasion in Hepatocellular Carcinoma Cells via Suppressing SMAD7

“…27 A previous study indicates that the AST-to-platelet ratio index can be used to predict long-term survival in patients with HCC following non-transplant therapies. 28 Furthermore, ALB is proved to be differentially expressed between tumor cells and non-tumor cells of patients with HCC. 29 A previous study proves that ALB is a predicator for patients with HCC.…”

Risk stratification of patients with hepatocellular carcinoma undergoing trans arterial chemoembolization using an alpha-fetoprotein model

“…There are multiple factors that could affect the malignancy and progression of HCC including tumor number, size, and macrovascular invasion, which are evaluated by radiological imaging before treatment [8]. Prognosis is also affected by the degree of hepatic dysfunction, patient comorbidities, and tumor biology [9]. Recently, the French study group for liver transplantation reported on a new predictive model for HCC recurrence, called the alpha-fetoprotein (AFP) model.…”