Published online Sep 28, 2015. doi: 10.3748/wjg.v21.i36.10262
Peer-review started: April 26, 2015
First decision: June 2, 2015
Revised: June 12, 2015
Accepted: August 30, 2015
Article in press: August 31, 2015
Published online: September 28, 2015
Processing time: 156 Days and 5.8 Hours
The natural history of cirrhosis varies and therefore prognostic prediction is critical given the sizable patient population. A variety of clinical prognostic indicators have been developed and enable patient risk stratification although their performance is somewhat limited especially within relatively earlier stage of disease. Molecular prognostic indicators are expected to refine the prediction, and potentially link a subset of patients with molecular targeted interventions that counteract poor prognosis. Here we overview clinical and molecular prognostic indicators in the literature, and discuss critical issues to successfully define, evaluate, and deploy prognostic indicators as clinical scores or tests. The use of liver biopsy has been diminishing due to sampling variability on fibrosis assessment and emergence of imaging- or lab test-based fibrosis assessment methods. However, recent rapid developments of genomics technologies and selective molecular targeted agents has highlighted the need for biopsy tissue specimen to explore and establish molecular information-guided personalized/stratified clinical care, and eventually achieve “precision medicine”.
Core tip: Molecular-based prediction of prognosis in liver cirrhosis is coming of age with the emergence of clinically applicable genomic assays, which are expected to further refine clinical indicator-based prognostication. Such biomarkers could also guide individualized molecular targeted therapeutic and/or preventive interventions to improve patient prognosis in the near future.