Published online Jun 27, 2019. doi: 10.4254/wjh.v11.i6.542
Peer-review started: March 12, 2019
First decision: April 10, 2019
Revised: May 16, 2019
Accepted: June 17, 2019
Article in press: June 17, 2019
Published online: June 27, 2019
Processing time: 108 Days and 20.5 Hours
It has been an urge to find a proper staging system for patients with hepatocellular carcinoma (HCC). The significance of this study is owed to comparing on a large scale a wide selection of scoring systems that included established [Child-Turcotte-Pugh (CTP), TNM and Barcelona Clinic Liver Cancer (BCLC)] and novel scoring systems (albumin-bilirubin (ALBI), plateltet-albumin–bilirubin (PALBI), ALBI-BCLC, ALBI-T and modified albumin-bilirubin-TNM (mALBI-T)].
Linear predictive equations based scoring systems (such as ALBI and PALBI) offer better performance than those based on predetermined cut-off points (CTP, TNM and BCLC). The best scoring system would be a linear function that incorporates liver function paramters and other tumor specific paramters such as alpha fetoprotein (AFP), tumor size and number.
We applied the tested scoring systems on our retrospective cohort and compared their performance using survival curves and AUROCS to predict survival in addition to patient stratification according to different scores.
Our findings proved that the modified version of ALBI-T score offered better stratification than the original score and is a better prognostic tool. It remains to be explored whether treatment modality specific scores would result in better performance than general scores or not and whether we need such specific scores or not.
This study offers a validation of the mALBI-T score in a large scale Egyptian cohort. mALBI-T performs better than the other investigated scoring systems such as ALBI and BCLC.
The best model for HCC patients should assess liver function, tumor number, size and other tumor specific paramters such as AFP. We suggest developing scores that include treatment response such as mRECIST criteria or recurrence status. Linear equations based scores are more precise and future scores should abandon old techniques that use predetermined points.