Model of End Stage Liver Disease Score and Hepatocellular Carcinoma

Abstract Background: Hepatocellular carcinoma (HCC0 is the most common primary hepatic malignancy worldwide [1]. It is the first cause of cancer mortality in Egypt [2] due tothe heavy burden of chronic HCV (14.7%). Among cirrhotic patients, 1-4% per year will develop HCC [3]. HCC patients evaluated for liver transplantation are often given exceptional MELD score, giving them a priority for liver transplantation. We aimed at determining the MELD score in HCC patients, its correlation with TNM tumour stage and tumour size. Also, we aimed at determining a cut off value of MELD score above which chronic HCV (CHC) cirrhotic patients have high chance to develop HCC.
Aim of Work: To determine the actual MELD score in HCC patients, its correlation with TNM stage and tumour size. Also, we aimed at termining a cut off value of MELD score above which chronic HCV (CHC) cirrhotic patients have a high chance to develop HCC.
Material and Methods: The study included 98 patients with CHC and HCC (group I) and 219 patients with CHC without HCC (group II). CHC was diagnosed by ELISA for HCV Antibody and serum HCV RNA. HCC diagnosis was based on EASL criteria i.e. focal hepatic lesion with arterial phase enhancement and washout in portal and delayed phases, obtained by contrast enhanced abdominal CT and/or MRI. HCC was staged according to the seventh edition TNM tumour staging system. MELD score was calculated using the follow-ing formula: MELD score=10 *[(0.957*In (Creatinine)] + [0.378*In (Bilirubin)] + [1.12*In (INR)] + 6.43. We used the MELD score calculator of the liver application of the EASL. We computed ROC curve for MELD score concerning the prediction of HCC. Stratum specific likelihood ratio (SSLR) was calculated as the pro-portion of diseased subjects (HCC) with a test result in a given range divided by the proportion of non-diseased subjects (non HCC) with a test result in the same range [4].
Results: MELD score was significantly higher in group I than group II. The score was 9.71±4.08 in group I versus 5.61±3.25 in group II (p£.000). In group I the MELD score ranged from 0.7 to 20.33. There was significant positive correlation between MELD score and TNM tumour stage (r=0.3 12, p=0.002) but the correlation was insignificant as regards the tumour size (r=0.041, p=0.687). The distribution of TNM tumour stage in group I was as follows: Stage I represented 19.3%, stage II represented 25.5%, stage IIIa represented 19.3%, stage IIIb represented 18.3%, stage IIIc represented 1%, stage IVa represented 8% and stage IVb represented 7%. The cut off value of MELD score above which there was a high risk of HCC development was  ³5.74. The area under the curve (AUC) was 78.3%, sensitivity was 87.8%, specificity was 56%, positive predictive value (PPV) of 46.7%, negative predictive value (NPV) of 91%, accuracy of 65.3% and positive likelihood ratio (LR) of 1.96. The SSLR for HCC presence by MELD score was 0.21 in score <5, 0.97 in score from 5 to 10 and 4.57 in score >10.
Conclusion: MELD score has significant positive corre-lation with TNM tumour stage in HCC cases. CHC patients with MELD score >10 have SSLR for HCC presence of 4.57 and are in need for closer follow-up.