The outcomes and prognostic factors of patients with hepatocellular carcinoma and Child-Turcotte-Pugh class B

Chia-Chu Fu; Yu-Jen Chen; Chien-Wei Su; Cheng-Yi Wei; Chi-Jen Chu; Pei-Chang Lee; Teh-Ia Huo; Yi-Hsiang Huang; Hui-Chun Huang; Jaw-Ching Wu; Ming-Chih Hou

doi:10.1097/JCMA.0000000000000975

The outcomes and prognostic factors of patients with hepatocellular carcinoma and Child-Turcotte-Pugh class B

J Chin Med Assoc. 2023 Oct 1;86(10):876-884. doi: 10.1097/JCMA.0000000000000975. Epub 2023 Aug 4.

Authors

Chia-Chu Fu¹, Yu-Jen Chen^{1

2}, Chien-Wei Su^{1

2

3

4}, Cheng-Yi Wei^{1

2}, Chi-Jen Chu^{1

2}, Pei-Chang Lee^{1

2}, Teh-Ia Huo^{5

6}, Yi-Hsiang Huang^{1

2

3}, Hui-Chun Huang^{1

2}, Jaw-Ching Wu³, Ming-Chih Hou^{1

2}

Affiliations

¹ Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
² Department of Internal Medicine, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
³ Institute of Clinical Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC.
⁴ Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
⁵ Division of Basic Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
⁶ Institute of Pharmacology, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC.

PMID: 37537726
DOI: 10.1097/JCMA.0000000000000975

Abstract

Background: The Child-Turcotte-Pugh (CTP) score is widely used for assessing the liver's functional reserve in patients with advanced chronic liver disease (ACLD) and hepatocellular carcinoma (HCC). This study aims to explore the outcomes of patients with HCC and CTP class B and to investigate the prognostic accuracy of prediction models for ACLD in these patients.

Methods: We retrospectively enrolled 1143 patients with HCC and CTP class B between 2007 and 2022. We divided the patients into three subgroups based on their CTP scores: CTP-B7, CTP-B8, and CTP-B9. We compared the corrected Akaike information criterion among each mortality prediction model, including the CTP score, albumin-bilirubin (ALBI) score, modified ALBI score, the model for end-stage liver disease (MELD), and MELD 3.0.

Results: Among the enrolled patients, 576 (50.3%) were in the CTP-B7 group, 363 (31.8%) were in the CTP-B8 group, and 204 (17.9%) were in the CTP-B9 group. After a median follow-up of 4.6 months (interquartile range IQR 1.8-17.2 months), 963 patients died, and the 5-year overall survival (OS) rate was 11.4%. The 5-year OS rates were 11.6%, 13.6%, and 8.3% in the CTP-B7, CTP-B8, and CTP-B9 groups, respectively. Patients in the CTP-B7 group and CTP-B8 group had comparable OS ( p = 0.089), both of which were better than those in the CTP-B9 group ( p < 0.001). Furthermore, the MELD 3.0 score had the lowest corrected akaike information criteria value and provided a more accurate mortality prediction than the MELD score, ALBI grade, modified ALBI grade, and CTP score.

Conclusion: Patients in the CTP-B7 and CTP-B8 groups had comparable OS, both of which were better than those in the CTP-B9 group. Moreover, MELD 3.0 provided the most accurate mortality prediction in patients with HCC and CTP class B.