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. 2016 Jul;89(1063):20150945.
doi: 10.1259/bjr.20150945. Epub 2016 May 10.

Three-dimensional conformal radiotherapy for locally advanced hepatocellular carcinoma with portal vein tumour thrombosis: evaluating effectiveness of the model for end-stage liver disease (MELD) score compared with the Child-Pugh classification

Eiichiro Okazaki  1 , Akira Yamamoto  1 , Norifumi Nishida  2 , Masao Hamuro  1 , Ryo Ogino  3 , Masako Hosono  1 , Yasuhiko Shimatani  1 , Shinichi Tsutsumi  1 , Shinichi Hamamoto  1 , Etsuji Sohgawa  1 , Atsushi Jogo  1 , Yukio Miki  1
Affiliations

Three-dimensional conformal radiotherapy for locally advanced hepatocellular carcinoma with portal vein tumour thrombosis: evaluating effectiveness of the model for end-stage liver disease (MELD) score compared with the Child-Pugh classification

Eiichiro Okazaki et al. Br J Radiol. 2016 Jul.

Abstract

Objective: The purpose of this study was to retrospectively evaluate the effectiveness of the model for end-stage liver disease (MELD) score compared with the Child-Pugh classification in patients who received three-dimensional conformal radiotherapy (3D CRT) for hepatocellular carcinoma (HCC) with portal vein tumour thrombosis (PVTT) by analyzing toxicity and prognostic factors.

Methods: 56 consecutive patients who had locally advanced HCC with PVTT treated by 3D CRT between September 2007 and April 2013 were retrospectively reviewed.

Results: The median survival time of all patients was 6.4 months. Receiver-operating characteristic (ROC) analysis identified MELD score = 7.5 [area under the curve (AUC) 0.81] and Child-Pugh score = 6.5 (AUC 0.86) as the best cut-off values for predicting the incidence of complications over Common Terminology Criteria for Adverse Events grade 2. There was no significant difference in the discrimination power between the MELD score and the Child-Pugh score on comparison of the two ROC curves (p = 0.17). On multivariate analysis, age, MELD score and radiotherapy dose were significant prognostic factors for overall survival (p = 0.021, 0.038 and 0.006, respectively). In contrast, the Child-Pugh classification, tumour response, PVTT response and the number of prior interventional radiologic treatments were not significant on multivariate analysis.

Conclusion: This study showed that the best MELD score cut-off value is 7.5 and that the MELD score is a better prognostic factor than the Child-Pugh classification in 3D CRT for HCC with PVTT.

Advances in knowledge: The MELD score is useful for predicting the risk of severe toxicities and the prognosis of patients treated with 3D CRT for PVTT.

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Figures

Figure 1.
Figure 1.
The receiver-operating characteristic curves of the model for end-stage liver disease (MELD) and Child–Pugh scores for predicting the incidence of severe acute toxicities after radiotherapy.
Figure 2.
Figure 2.
The receiver-operating characteristic curves of the model for end-stage liver disease (MELD) and Child–Pugh scores for predicting survival at 3 months after radiotherapy.
Figure 3.
Figure 3.
Kaplan–Meier survival curves according to the model for end-stage liver disease (MELD) score with a cut-off value of 7.5 (p = 0.0014).
Figure 4.
Figure 4.
Kaplan–Meier survival curves according to the model for end-stage liver disease (MELD) score with a cut-off value of 10.5 (p = 0.032).
See this image and copyright information in PMC

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