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Validation of serological models for staging and prognostication of HCC in patients from a Japanese nationwide survey

  • Original Article—Liver, Pancreas, and Biliary Tract
  • Published:
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Abstract

Background

Two serology-based scoring models for prognostication of patients with hepatocellular carcinoma (HCC), the BALAD and BALAD-2 models, were applied to a Japanese cohort of a nationwide follow-up survey of HCC. The ability of these models to predict the progression of HCC and the deterioration of liver function and to assess prognosis was evaluated.

Methods

BALAD and BALAD-2 scores were calculated in 24,029 patients from a cohort of Japanese nationwide survey based on the serum levels of five markers (bilirubin, albumin, lens culinaris agglutinin-reactive alpha-fetoprotein, alpha-fetoprotein, and des-gamma-carboxy prothrombin) measured at the time of HCC diagnosis. The associations of these scores with the progression of HCC and liver function and with survival rates were analyzed.

Results

There were good correlations between BALAD and BALAD-2 scores and the progression of HCC and Child–Pugh class. Both scores accurately categorized patients into risk groups with different survival rates. BALAD-2 showed superior discrimination of patient survival compared with the original BALAD.

Conclusions

Serology-based scoring models for prognostication, especially the BALAD-2 model, were useful for staging and prognostication of survival in a cohort of Japanese patients with HCC from a nationwide survey.

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Authors and Affiliations

  1. Department of Gastroenterology, Ogaki Municipal Hospital, 4-86 Minaminokawa, Ogaki, Gifu, 503-8502, Japan

    Hienori Toyoda, Toshifumi Tada & Takashi Kumada

  2. Institute of Translational Medicine, University of Liverpool, Liverpool, UK

    Philip J. Johnson

  3. Department of Gastroenterology, Musashino Red Cross Hospital, Tokyo, Japan

    Namiki Izumi

  4. Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan

    Masumi Kadoya

  5. Department of Gastroenterology, Kanazawa University Hospital, Kanazawa, Japan

    Shuichi Kaneko

  6. Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    Norihiro Kokudo

  7. Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan

    Yonson Ku

  8. Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan

    Shoji Kubo

  9. Department of Biostatics, School of Public Health, University of Tokyo, Tokyo, Japan

    Yutaka Matsuyama

  10. Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume, Japan

    Osamu Nakashima

  11. Department of Pathology, Keio University School of Medicine, Tokyo, Japan

    Michiie Sakamoto

  12. Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan

    Tadatoshi Takayama

  13. Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka, Japan

    Masatoshi Kudo

Authors
  1. Hienori Toyoda
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  2. Toshifumi Tada
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  3. Philip J. Johnson
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  4. Namiki Izumi
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  5. Masumi Kadoya
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  6. Shuichi Kaneko
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  7. Norihiro Kokudo
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  8. Yonson Ku
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  9. Shoji Kubo
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  10. Takashi Kumada
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  13. Michiie Sakamoto
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  14. Tadatoshi Takayama
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  15. Masatoshi Kudo
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The Liver Cancer Study Group of Japan

Corresponding author

Correspondence to Hienori Toyoda.

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The authors declare that they have no conflict of interest.

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Supplementary material 1 (DOC 23 kb)

535_2017_1321_MOESM2_ESM.pptx

Supplementary material 2 (PPTX 221 kb) Supplementary figure S1. Selection flowchart of the study patients in a cohort of a Japanese nationwide survey of patients with HCC. Supplementary figure S2. Survival rates of patients with intermediate BALAD scores. A) Comparison of survival rates of patients with BALAD score 3 between patients with 1 elevated tumor marker (deteriorated liver function predominant) and patients with 3 elevated tumor markers (tumor progression predominant). No significant difference was found (p = 0.3873). B) Comparison of survival rates of patients with BALAD score 2 between patients with 0 elevated tumor marker (deteriorated liver function predominant) and patients with 2 elevated tumor markers (tumor progression predominant). No significant difference was found (P = 0.6990). Supplementary figure S3. Survival rates of patients with hepatocellular carcinoma (HCC) after diagnosis by original BALAD scores evaluated by serum levels of the following measured at the diagnosis of HCC: ALB, T-Bil, AFP, AFP-L3, and DCP. A) Patients with hepatitis B virus (HBV) infection; B) Patients with hepatitis C virus (HCV) infection; C) Patients without hepatitis virus infection (non-HBV/HCV). Supplementary figure S4. Survival rates of patients with hepatocellular carcinoma (HCC) who undergone A) curative, B) intermediate, and C) palliative or no treatment after diagnosis by original BALAD scores evaluated by serum levels of the following measured at the diagnosis of HCC: ALB, T-Bil, AFP, AFP-L3, and DCP. Supplementary figure S5. Survival rates of patients with hepatocellular carcinoma (HCC) after diagnosis based on Japan Integrated Staging scores evaluated at the diagnosis of HCC. Dotted lines, 95% confidence intervals (CIs)

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Toyoda, H., Tada, T., Johnson, P.J. et al. Validation of serological models for staging and prognostication of HCC in patients from a Japanese nationwide survey. J Gastroenterol 52, 1112–1121 (2017). https://doi.org/10.1007/s00535-017-1321-6

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  • DOI: https://doi.org/10.1007/s00535-017-1321-6

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