Correlation Of Model For End-stage Liver Disease Score And Liver Function And Syndromes Of Traditional Chinese Medicine In Patients With Primary Hepatic Cancer

Background and ObjectiveModel for end-stage liver disease (MELD), which is based on the calculation from three biochemical variables (serum bilirubin, prothrombin time and creatinine), has been shown to more accurately predict the survival than the Child-Turcotte-Pugh (CTP) classification for cirrhotic patients awaiting liver transplantation in the US. The liver allocation system has subsequently changed from a status-based algorithm to one using a continuous MELD severity scale to prioritize adult patients on the wait list. Moreover, the MELD was shown to predict mortality independent of aetiology of the liver disease and the occurrence of complications of portal hypertension. The accuracy of MELD for outcome prediction in patients with decompensated cirrhosis has also been validated in other centers and in Europe. Primary hepatic cancer (PHC) is one of the common malignant tumours in the world. The majority of PHC patients have coexisting liver cirrhosis at the time of diagnosis, and the severity of cirrhosis is probably the most important non-tumoural factor to affect the survival. Several studies have recently shown the importance of incorporating the MELD into the prognostic model for PHC. In China alone, about 235,000 new cases of this cancer occur each year. This study was to investigate the evaluation of MELD for prediction of liver function and mortality in Chinese patients with PHC and the correlation of MELD score and syndromes of Traditional Chinese Medicine in patients with PHC.Part One MELD Score for Prediction of Liver Function in Patients with PHCProbability of MELD score for prediction of liver function and mortality in patients with PHCMethods A total of 203 patients with PHC were enrolled into the study from January 2005 to March 2009. MELD score was calculated for each patient following the original formula on the first day of admission. All patients were followed up at least 1 year. The predictive prognosis related with the MELD and CTP scoring models was determined by the area under the receiver operating characteristic curve (AUC). Spearman's correlation analysis was used to estimate the correlation and significance between the CTP scores in patients with PHC and the corresponding MELD scores. Kaplan-Meier survival curves were made using the cut-offs identified by means of receiver operating characteristic (ROC).Results The AUC values for 3,6 and 12 months survival were 0.732,0.618 and 0.622 for MELD score. Using the cutoffs that had the best discriminative ability to predict mortality derived from the ROC curve at 3 months of enrollment, we determined the sensitivity, specificity, positive predictive value, and negative predictive value for MELD score were 75.00%,61.00%,34.70% and 89.80%, respectively. There were significant correlations between MELD scores and CTP scores and CTPclass (rs=0.592, P=0.000 and rs=0.623, P=0.000, respectively). The MELD scores≥10.0 and≥14.0 succeeded to differentiate patients in CTP class B (χ2=3.960,P=0.047) and CTP class C (χ2=6.429, P=0.011), respectively.Value of MELD score for predicting survival in unresectable PHC patients treated with trans-catheter arterial chemoembolisationMethods A total of 163 patients with unresectable PHC were enrolled into the study, who underwent trans-catheter arterial chemoembolisation (TACE) for the initial treatment of PHC from January 2005 to March 2009. MELD score was calculated for each patient following the original formula on the first day of admission. All patients were followed up at least 1 year. Survival curves were plotted with the Kaplan-Meier method and were compared by using a log-rank test. Univariate and multivariable proportional hazards analysis were used to determine the relationship between risk factors and mortality.Results The median survival time of patients was 23.4 months. MELD score significantly correlated with survival, while CTP class not. The patients whose MELD scores≥10.0 would have a poor probability of survival by univariate analysis (χ2=5.974, P=0.015). Univariate analysis of determinants for mortality were age, gender, serum albumin, serum aspartate aminotransferase, aspartate aminotransferase/alanine aminotransferase, serum alkaline phosphatase, serum prealbumin, serumγ-glutamyltransferase, MELD score, tumor size, venous tumor thrombus, tumor metastasis, tumor,nodes,metastasis (TNM) staging system, Chinese tumor clinic staging system, times of TACE, treatment with traditional Chinese medicine (TCM) and antiviral therapy. By multivariable analysis, age, gender, TNM staging system, serum prealbumin, serum y-glutamyltransferase and treatment with TCM could quantify the risk of mortality in patients with unresectable PHC, independently of the procedure performed. The treatment with TCM was the significant favorable prognostic factor for unresectable PHC patients treated with TACE.Part Two MELD score and Syndromes of TCM in patients with PHCMethods A total of 278 patients with PHC were enrolled into the study from January 2005 to March 2009. MELD score was calculated for each patient following the original formula on the first day of admission. All patients were followed up at least 1 year. Discriminant analysis and multivariable linear regression were used to estimate the correlation and significance between the syndromes of TCM in patients with PHC and the corresponding MELD scores. All patients were classified into four groups with MELD scores≤6.0,6.0-10.0,10.0-14.0 and≥14.0. The following factors such as age, tumor size and some clinic biochemistry parameters were considered as independent variables. The syndromes of TCM in patients with PHC were considered as catagorical variables. Survival curves were plotted with the Kaplan-Meier method and were compared by using a log-rank test.Results The average MELD scores for single, two, three and four syndromes of TCM in patients were 3.8±2.6,5.1±3.5,5.6±4.8 and 7.1±4.7, respectively. MELD scores were statistically significant between the single syndrome and complicated syndromes of TCM in patients (F=8.322,.P=0.000), and, the survival and death in patients with excess syndrome and more-deficiency-excess compex syndromes of TCM (Z=-2.037, P=0.042 and Z=-2.333, P=0.020, respectively). MELD score could discriminate the syndromes of TCM in patients with the coincidence rate 48.30%,65.10%,93.30% and 100.00% for MELD scores≤6.0,6.0-10.0,10.0-14.0 and≥14.0, respectively. There were significant correlation between the syndromes of water-dampness, blood stagnation and excess heat in patients with PHC and the corresponding MELD scores by multiple linear regression analysis.ConclusionsMELD score can exactly predict the liver function and prognosis of patients with PHC for short period. The classification with the MELD scores≤6.0,6.0-10.0,10.0-14.0 and≥14.0 can quantify the risk of mortality in patients with PHC. With the MELD scores≥10.0, TACE must be planned with a great deal of caution because of the poor probability of survival in patients with PHC. There is correlation between MELD scores and syndromes of TCM in patients with PHC. The higher MELD scores were, the more complicated syndromes of TCM were. The syndromes of water-dampness blood stagnation and excess heat in patients with PHC were in close relations with the higher MELD scores.