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King's score as a novel prognostic model for patients with hepatitis B-associated hepatocellular carcinoma
Qing Pang1, Jian-Bin Bi, Xin-Sen Xu
1Department of Hepatobiliary Surgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, China.
Insights
The King's score (KS) effectively predicts survival in hepatitis B-associated hepatocellular carcinoma (HCC). A higher KS indicates a worse prognosis, aiding in patient management for this liver cancer.
Area of Science:
- Hepatology
- Oncology
- Biostatistics
Background:
- Hepatocellular carcinoma (HCC) is a major complication of chronic liver disease, particularly in hepatitis B infections.
- The King's score (KS) was developed to assess cirrhosis and HCC risk.
- Prognostic value of KS in hepatitis B-associated HCC requires further investigation.
Purpose of the Study:
- To evaluate the prognostic significance of the King's score (KS) in patients with hepatitis B-associated HCC.
- To determine if KS can predict overall survival (OS) and disease-free survival (DFS) in this patient cohort.
Main Methods:
- Retrospective analysis of 319 patients with hepatitis B-associated HCC.
- Calculation of preoperative KS (age × AST × INR/platelet count).
- Kaplan-Meier survival analysis and multivariate Cox regression for OS and DFS.
Main Results:
- A KS cutoff of 33.31 was identified, with higher scores correlating with cirrhosis and worse Child-Pugh class.
- High KS was an independent predictor of poor OS and DFS, alongside age, tumor size, palliative therapy, and BCLC stage.
- KS combined with tumor size demonstrated superior survival discrimination compared to BCLC stage.
Conclusions:
- The King's score (KS) is a valuable tool for predicting OS and DFS in hepatitis B-associated HCC.
- Further validation in larger cohorts is recommended to confirm these findings.
Background And Objectives:
King's score (KS) has been developed to predict the presence of cirrhosis and hepatocellular carcinoma (HCC) in patients with chronic liver diseases. We aimed to investigate the prognostic significance of the KS in hepatitis B-associated HCC.
Patients And Methods:
We retrospectively analyzed 319 hepatitis B-associated HCC patients. Preoperative data were collected to calculate the KS (age × aspartate aminotransferase × international normalized ratio/platelet count). The primary outcomes were overall survival (OS) and disease-free survival (DFS), which was estimated using the Kaplan-Meier method. Then, we carried out a multivariate Cox analysis to assess the independent significance of the KS. Additional analyses were carried out after patients were stratified on the basis of cirrhosis status and therapy methods to investigate the significance of KS in different subgroups.
Results:
During a median follow-up period of 44 months, 199 (62.4%) patients died and 144 (45.1%) experienced recurrence. The cut-off value for the KS was determined to be 33.31 with 56.8% sensitivity and 66.7% specificity. Compared with patients with low KS, the high group showed a higher probability of cirrhosis and worse Child-Pugh class (both P<0.05). Multivariate analysis identified older age, tumor size 5 or more, palliative therapy, high Barcelona Clinic Liver Cancer stage, and high KS as significant factors for predicting poor OS and DFS. A combination of the KS and tumor size showed better discrimination ability for survival than Barcelona Clinic Liver Cancer stage.
Conclusion:
The KS is an effective index for predicting OS and DFS in hepatitis B-associated HCC. Larger cohorts are needed to validate our finding.
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