MELD score and AST-to-platelet ratio index (APRI) predict long-term survival in patients with a small hepatocellular carcinoma following non-transplant therapies: a pilot study

Abstract

Aim: Liver transplantation (LT) is the most effective treatment for long-term survival from hepatocellular carcinoma (HCC); however, insufficient donors limit therapy. We sought to identify characteristics that predicted long-term survival after non-transplant therapies in patients with small HCC.

Methods: In a database of 1,050 HCC patients, we identified those with single HCC ≤ 3.0 cm, who underwent hepatic resection (HR, n = 16), radiofrequency ablation (RFA, n = 55), or LT (n = 23) with 5-years follow-up. Survival and odds-ratios for survival (OS) after HR/RFA were calculated for MELD score, platelet count, creatinine, albumin, AST/Platelet Ratio Index (APRI), INR, and bilirubin.

Results: LT patients had 3 and 5-year OS of 82.6% and 73.9% compared 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% 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.

Keywords: Hepatocellular carcinoma; ablation; liver resection; transplant.

Figure 1. Modified overall 3-year and 5-year survival for selected patient characteristics

LT: liver transplantation; APRI: AST-to-platelet ratio index; MELD: Model for End Stage Liver Disease; Cr: creatinine; CTP: Child-Turcotte-Pugh score; Alb: albumin; DM: diabetes mellitus