BACKGROUND & AIMS: Previously proposed staging systems for hepatocellular carcinoma (HCC) involve clinical, imaging, or pathologic factors in the evaluation. We established and validated a novel staging system for HCC that is based on simply serum markers. METHODS: The new scoring system is based on 5 serum markers: bilirubin, albumin, Lens culinaris agglutinin-reactive alpha-fetoprotein (AFP-L3), alpha-fetoprotein (AFP), and des-gamma-carboxy prothrombin (DCP) and thus is termed the BALAD score. The system was validated in 2600 HCC patients from 5 institutions. The power of our system to predict patient survival and its discriminative ability were compared with those of previously reported staging systems. RESULTS: The best tumor marker cutoff values were 400 ng/dL for AFP, 15% for AFP-L3, and 100 milli-arbitrary unit/mL for DCP. The patients were classified into 6 categories on the basis of 5 laboratory values. The categories reflected patient survival well. The discriminative ability was comparable to that of previously reported staging systems. CONCLUSIONS: The new staging system for HCC combining serum albumin, serum bilirubin, and 3 tumor markers predicts patient outcomes with excellent discriminative ability. The system is easy to use and objective. In addition, stage can be evaluated with the use of only 1 serum sample. It also allows global comparison of patients with HCC or comparison of patients from different time periods with the same standard.
BACKGROUND & AIMS: Previously proposed staging systems for hepatocellular carcinoma (HCC) involve clinical, imaging, or pathologic factors in the evaluation. We established and validated a novel staging system for HCC that is based on simply serum markers. METHODS: The new scoring system is based on 5 serum markers: bilirubin, albumin, Lens culinaris agglutinin-reactive alpha-fetoprotein (AFP-L3), alpha-fetoprotein (AFP), and des-gamma-carboxy prothrombin (DCP) and thus is termed the BALAD score. The system was validated in 2600 HCC patients from 5 institutions. The power of our system to predict patient survival and its discriminative ability were compared with those of previously reported staging systems. RESULTS: The best tumor marker cutoff values were 400 ng/dL for AFP, 15% for AFP-L3, and 100 milli-arbitrary unit/mL for DCP. The patients were classified into 6 categories on the basis of 5 laboratory values. The categories reflected patient survival well. The discriminative ability was comparable to that of previously reported staging systems. CONCLUSIONS: The new staging system for HCC combining serum albumin, serum bilirubin, and 3 tumor markers predicts patient outcomes with excellent discriminative ability. The system is easy to use and objective. In addition, stage can be evaluated with the use of only 1 serum sample. It also allows global comparison of patients with HCC or comparison of patients from different time periods with the same standard.
Authors: Philip J Johnson; Sarah Berhane; Chiaki Kagebayashi; Shinji Satomura; Mabel Teng; Helen L Reeves; James O'Beirne; Richard Fox; Anna Skowronska; Daniel Palmer; Winnie Yeo; Frankie Mo; Paul Lai; Mercedes Iñarrairaegui; Stephen L Chan; Bruno Sangro; Rebecca Miksad; Toshifumi Tada; Takashi Kumada; Hidenori Toyoda Journal: J Clin Oncol Date: 2014-12-15 Impact factor: 44.544
Authors: Anna S Lok; Richard K Sterling; James E Everhart; Elizabeth C Wright; John C Hoefs; Adrian M Di Bisceglie; Timothy R Morgan; Hae-Young Kim; William M Lee; Herbert L Bonkovsky; Jules L Dienstag Journal: Gastroenterology Date: 2009-10-20 Impact factor: 22.682
Authors: Abdelfattah M Attallah; Mohamed El-Far; Mohamed M Omran; Mohamed A Abdelrazek; Ahmed A Attallah; Aya M Saeed; Khaled Farid Journal: Tumour Biol Date: 2016-07-05