A comparison of clinical manifestations and prognoses between patients with hepatocellular carcinoma and Child-Pugh scores of 5 or 6

Abstract

The objective of this work is to compare the outcomes between the Child-Pugh score 5 (A5 group) and Child-Pugh score 6 (A6 group) in patients with hepatocellular carcinoma (HCC). Whether HCC patients with A5 and A6 groups have different prognoses is still obscure. We enrolled 2462 consecutive treatment-naive HCC patients from 2007 to 2012. Among them, 1486 patients had Child-Pugh grade A, including 1016 in the A5 group and 470 in the A6 group. Factors in the prognoses were analyzed by multivariate analysis. Compared with those in the A6 group, patients in the A5 group were younger, had higher proportions of tumors within the Milan criteria, and more of them underwent curative therapies. The cumulative survival rates at 5 years were 51.3% and 37.1% for patients in the A5 and A6 groups, respectively (P < 0.001). Multivariate analysis showed that the independent risk factors associated with poor overall survival were nonhepatitis C virus carrier, serum albumin ≤ 4 g/dL, aspartate aminotransferase > 45 U/L, α-fetoprotein > 20 ng/mL, multinodularity, tumor size > 3 cm, vascular invasion, and noncurative therapies, but not the Child-Pugh numeric score. The Child-Pugh numeric score had a significant prognostic effect only in patients who had tumors beyond the Milan criteria and received noncurative therapies. HCC patients with A5 group had a better overall survival rate than those with A6 group due to the early tumor stage and higher rate of receiving curative treatments. Tumor factors and treatment modalities were more important than the Child-Pugh numeric score.

FIGURE 1

The study flow chart. HCC = hepatocellular carcinoma, RFA = radiofrequency ablation therapy, TACE = transarterial chemoembolization.

FIGURE 2

The cumulative curves of overall survival rates stratified by Child–Pugh numeric score, tumor stage, and treatment modality. The overall survival rate was higher in patients who were in the A5 group (A, P < 0.001), underwent curative treatment (B, P < 0.001), and had tumor stages within the Milan criteria (C, P < 0.001). A5 group = Child–Pugh score 5, A6 group = Child–Pugh score 6.

FIGURE 3

The comparison of overall survival between A5 and A6 groups in stratified analysis by forest plot. A5 group = Child–Pugh score 5, A6 group = Child–Pugh score 6, AFP = α-fetoprotein, ALT = alanine aminotransferase, AST = aspartate aminotransferase, CI = confidence interval, HBsAg = hepatitis B surface antigen, HCV = hepatitis C virus, HR = hazards ratio, RFA = radiofrequency ablation therapy, TACE = transarterial chemoembolization.

FIGURE 4

Comparison of cumulative overall survival rates between A5 and A6 groups stratified by the BCLC stage. The overall survival rates were comparable between the A5 and A6 groups in the setting of BCLC stage 0 (A) and stage A (B). However, the overall survival rates were higher in the A5 group compared with the A6 group in patients with BCLC stage B (C), stage C (D), and stage D (E). A5 group = Child–Pugh score 5, A6 group = Child–Pugh score 6, BCLC = Barcelona Clinic Liver Cancer.

FIGURE 5

The comparison of cumulative overall survival rates between A5 and A6 groups stratified by tumor stage and treatment modality. (A) Patients with tumors within the Milan criteria who underwent curative therapy, (B) patients with tumors within the Milan criteria who underwent noncurative therapy, (C) patients with tumors beyond the Milan criteria who underwent curative therapy, and (D) patients with tumors beyond the Milan criteria who underwent noncurative therapy. A5 group = Child–Pugh score 5, A6 group = Child–Pugh score 6.