Page 87 - Read Online

Sarkar et al. Hepatoma Res 2017;3:79-85 Hepatoma Research
DOI: 10.20517/2394-5079.2017.06
www.hrjournal.net
Original Article Open Access

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

Joy Sarkar , Thomas DeLeon , Linda L. Wong
2
3
1
1 Tripler Army Medical Center, Surgery, Honolulu, HI 96813, USA.
2 Department of Medicine, John A. Burns School of Medicine, Honolulu, HI 96813,USA.
3 Department of Surgery, John A. Burns School of Medicine, Honolulu, HI 96813, USA.
Correspondence to: Prof. Linda L. Wong, Department of Surgery, John A. Burns School of Medicine, 550 S. Beretania Street, Suite 403, Honolulu, HI
96813, USA. E-mail: Hepatoma@aol.com

How to cite this article: Sarkar J, DeLeon T, Wong LL. 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. Hepatoma Res 2017;3:79-85.
ABSTRACT
Article history: Aim: Liver transplantation (LT) is the most effective treatment for long-term survival from
Received: 26-02-2017 hepatocellular carcinoma (HCC); however, insufficient donors limit therapy. The authors
Accepted: 13-04-2017 sought to identify characteristics that predicted long-term survival after non-transplant
Published: 09-05-2017 therapies in patients with small HCC. Methods: In a database of 1,050 HCC patients, the
authors identified those with single HCC ≤ 3.0 cm, who underwent hepatic resection (HR, n
Key words: = 16), radiofrequency ablation (RFA, n = 55), or LT (n = 23) with 5-year follow-up. Overall
Hepatocellular carcinoma, survival (OS) and odds-ratios (OR) for survival after HR/RFA were calculated for MELD score,
ablation, platelet count, creatinine, albumin, AST/platelet ratio index (APRI), international normalized
liver resection, ratio, and bilirubin. Results: LT patients had 3- and 5-year OS of 82.6% and 73.9% compared
transplant 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% confidence interval (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.

INTRODUCTION second leading cause of cancer-related mortality
with 745,000 deaths. [1,2] Advanced stage at diagnosis
Hepatocellular carcinoma (HCC) is the most common and poor underlying liver function present major
primary malignancy of the liver. Worldwide, there challenges to treatment. Potential curative therapies
were 782,000 new cases in 2012 and HCC is the for HCC include hepatic resection (HR) and liver

Quick Response Code:
This is an open access article distributed under the terms of the Creative Commons Attribution-
NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work
non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

For reprints contact: service@oaepublish.com

© 2017 OAE Publishing Inc. www.oaepublish.com 79