Model of End-Stage Liver Disease-alpha-fetoprotein-tumor burden (MELD-AFP-TBS) score to stratify prognosis after liver resection for hepatocellular carcinoma

Jun Kawashima ¹, Miho Akabane ², Mujtaba Khalil ²

¹Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH; Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan.
²Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH.
³Department of Transplant Surgery, University of Rochester Medical Center, Rochester, NY.
⁴Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan.
⁵Division of General and Hepatobiliary Surgery, University of Verona, Verona, Italy.
⁶Department of Surgery, San Raffaele Hospital, Milan, Italy.
⁷Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
⁸Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.
⁹Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia.
¹⁰Department of Surgery, Stanford University, Stanford, CA.
¹¹Department of Surgery, Keio University, Tokyo, Japan.
¹²Department of Surgery, Fundeni Clinical Institute, Bucharest, Romania.
¹³Department of Surgery, University of Ottawa, Ottawa, ON, Canada.
¹⁴Department of Surgery, University of Colorado Denver, Denver, CO.
¹⁵Department of Surgery, The University of Sydney, Sydney, New South Wales, Australia.
¹⁶Department of Surgery, Cancer Institute, Northwell Health, New Hyde Park, NY.
¹⁷Department of Hepato-pancreato-biliary & Liver Transplant Surgery, Cleveland Clinic Foundation, Digestive Diseases and Surgery Institute, Cleveland, OH.

⁰Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH; Department of Gastroenterological Surgery, Yokohama City University, Yokohama, Japan.

Surgery +

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May 1, 2025

View abstract on PubMed

Summary

A new risk score combining Model of End-Stage Liver Disease (MELD), alpha-fetoprotein, and tumor burden accurately predicts survival in hepatocellular carcinoma patients. This MELD-AFP-TBS score improves prognostic stratification over existing methods.

Area Of Science

Hepatology
Oncology
Medical Statistics

Background

Morphologic criteria like the Barcelona Clinic Liver Cancer staging system have limitations in predicting long-term survival for hepatocellular carcinoma (HCC) patients undergoing liver resection.
Accurate prognostic tools are needed to guide treatment decisions and improve patient outcomes.

Purpose Of The Study

To develop and validate a continuous risk score for predicting overall survival in HCC patients after curative-intent hepatectomy.
To incorporate established markers of tumor biology and liver function into a novel predictive model.

Main Methods

A multivariable Cox regression model was used to develop a predictive score using data from a multi-institutional database of 850 patients.
The score, termed the Model of End-Stage Liver Disease-alpha-fetoprotein-tumor burden (MELD-AFP-TBS) score, was validated in a separate test cohort.

Main Results

The MELD-AFP-TBS score identified independent predictors of worse survival: Model of End-Stage Liver Disease, log-transformed alpha-fetoprotein, and tumor burden score.
The MELD-AFP-TBS score effectively stratified patients into low-risk and high-risk groups with significantly different 5-year overall survival rates (70.5% vs. 47.0%, P < .001).
The MELD-AFP-TBS score demonstrated superior discriminative accuracy compared to the Barcelona Clinic Liver Cancer staging system in both training and test cohorts.

Conclusions

The MELD-AFP-TBS score offers a novel and accurate tool for prognostic stratification in HCC patients.
This score can identify high-risk individuals who may benefit from alternative treatment strategies to improve outcomes.
An online tool is available for clinical application of the MELD-AFP-TBS score.