The model for end‐stage liver disease‐based Japan Integrated Scoring system may have a better predictive ability for patients with hepatocellular carcinoma undergoing locoregional therapy

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Abstract
BACKGROUND The Japan Integrated Scoring (JIS) system was revealed as a better model for outcome prediction compared with the Cancer of Liver Italian Program system for hepatocellular carcinoma (HCC), and the Model for End‐Stage Liver Disease (MELD) was better as a prognostic predictor for patients with cirrhosis compared with the Child–Turcotte–Pugh (CTP) system, which is a parameter used in the JIS system. The objective of the current study was to investigate the performance of the modified MELD‐based JIS system. METHODS In the modified JIS system, the CTP class in the original JIS was replaced with MELD cut‐off scores of 14. The modified JIS system was compared with the original system in 276 patients with HCC who underwent locoregional therapy (transarterial chemoembolization or percutaneous injection). RESULTS The mean ± standard error original JIS score was 1.8 ± 1.0 (range, 0‐4), compared with 2.0 ± 1.1 (range, 0‐5) for the modified JIS system (P<.001). Using mortality as the endpoint, the area under receiver operating characteristic curve (AUC) for the modified JIS system was 0.804 compared with 0.741 for the original JIS system (P = .008) at 12 months, and the AUC was 0.853 and 0.765, respectively (P<.001), at 24 months. Survival analysis showed that the modified JIS system had a better discriminatory ability for patients in different score groups and was more accurate for outcome prediction in the Cox multivariate model. CONCLUSIONS The current results indicated that the MELD‐based, modified JIS system has improved predictive ability compared with the original system and is a more feasible model for clinical staging in patients with HCC who are undergoing locoregional therapy. Cancer 2006. © 2006 American Cancer Society.