Epidemiology

New scoring system points to liver cancer outcome

Last Updated: 2005-02-23 14:41:12 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The Tokyo score, a novel prognostic system, accurately predicts outcome in Japanese patients with hepatocellular carcinoma (HCC), according to a report in the March issue of Gut.

Dr. R. Tateishi and colleagues from University of Tokyo developed the score, which ranges from 0 to 6 and involves serum albumin, bilirubin, and size and number of tumors.

The investigators tested its validity in 403 consecutive patients with HCC treated by percutaneous ablation and in 203 patients who underwent hepatectomy.

Five-year survival rates fell significantly with increases in Tokyo score, the authors report. They declined from 78.7% for patients with Tokyo scores of 0, to 14.3% for patients with Tokyo scores between 4 and 6.

In Cox proportional hazard regression models, the Tokyo score proved equal to the Cancer of the Liver Italian Program (CLIP) scoring system for HCC, and better than Barcelona Clinic Liver Cancer (BCLC) staging. Overall, the researchers note, the Tokyo score appeared to be more informative than the other two systems.

"We established the Tokyo score by analyzing survival time among HCC patients treated with medical ablation and validated it in patients who underwent surgical resection," the authors conclude. "The Tokyo score may be useful in predicting the prognosis of HCC patients who are candidates for these curative treatments."

In an accompanying editorial, Dr. S. Ryder from Queen's Medical Centre, Nottingham, UK notes that "it should be emphasized that these are not natural history based models; almost all patients had therapy and some patients had more than one treatment modality."

Thus he points out that the outcome "is subject to the impact of many treatment related effects on survival which may not be reproducible in standard clinical practice."

Gut 2005;54:419-425,328-329.