The Kings Score refines prognostic prediction in hepatocellular carcinoma: a novel application

Abstract

The KS integrates into the BCLC system to improve prognostic substratification in the palliative setting of care. The KS may help reducing disease heterogeneity and refine treatment allocation in intermediate-advanced HCC.

Prognostic Performance of Ten Liver Function Models in Patients with Hepatocellular Carcinoma Undergoing Radiofrequency Ablation

“…Although APRI, FIB-4 index and King’s score were used to assess the severity of liver fibrosis, previously studies demonstrated that these three models have been evaluated as prognostic models for HCC 24 , 30 , 41 . Of particular interest, APRI and FIB-4 may predict recurrence of HCC.…”

“…Alternative tools to evaluate liver functions are fibrosis index based on 4 factors (FIB-4) and aspartate aminotransferase-to- platelet ratio (APRI) 21 – 26 ; these models comprise clinical parameters such as age and serum biochemistry. Other models, including Lok index 14 , 27 , cirrhosis discriminant index (CDS) 28 , King’s score 29 , 30 , and Göteborg University Cirrhosis Index (GUCI) 31 , are also used; these models can be readily calculated from clinical variables such as age, serum aspartate aminotransferase, alanine aminotransferase, international normalized ratio of prothrombin (INR) and platelet count. To date, at least ten noninvasive liver function models have been used to define the severity of hepatic dysfunction.…”

Application of the King's score as a prognostic model for hepatocellular carcinoma: still a long way to go

“…The dual roles of PLT may partly determine the potential limitation of the KS in predicting HCC prognosis. In addition, among the training set by Pinato et al (1), up to 20 percents of HCC patients had extrahepatic metastasis and metastasis was found to be the most powerful prognostic factor for HCC (their Table 2). We believe that such a high metastatic rate in training set may be caused by high PLT (their Table 1, median: 199 9 10 9 /L in training set vs. 131 9 10 9 /L in validation set).…”

“…The recent accepted article by Pinato et al (1) demonstrated that hepatocellular carcinoma (HCC) patients with high level of the King's Score (KS) [age 9 aspartate aminotransferase 9 international normalized ratio/platelets] had poor survival, in both training and validation cohorts. We want to point out the potential limitations of this index in predicting HCC outcome.…”

“…Thirdly, therapeutic method is a crucial prognostic factor for HCC even in patients with the same BCLC stage. To obtain more data, Pinato et al (1) analysed the prediction ability of the KS without distinguishing patients with curative treatment from those with palliative therapy.…”