Model for End-Stage Liver Disease and Sodium Velocity Predicts Overall Survival in Nonmetastatic Hepatocellular Carcinoma Patients
Background & Aims. The significance of short-term changes in model for end-stage liver disease and Sodium (MELD-Na) following hepatocellular carcinoma (HCC) diagnosis is unknown. In this report, we explore the value of the rate of short-term changes in MELD-Na as an independent predictor of mort...
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Canadian Journal of Gastroenterology and Hepatology |
| Online Access: | http://dx.doi.org/10.1155/2018/5681979 |
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| author | Justin Y. Tang Nitin Ohri Rafi Kabarriti Santiago Aparo Jennifer Chuy Sanjay Goel Jonathan M. Schwartz Milan Kinkhabwala Andreas Kaubisch Chandan Guha |
| author_facet | Justin Y. Tang Nitin Ohri Rafi Kabarriti Santiago Aparo Jennifer Chuy Sanjay Goel Jonathan M. Schwartz Milan Kinkhabwala Andreas Kaubisch Chandan Guha |
| author_sort | Justin Y. Tang |
| collection | DOAJ |
| description | Background & Aims. The significance of short-term changes in model for end-stage liver disease and Sodium (MELD-Na) following hepatocellular carcinoma (HCC) diagnosis is unknown. In this report, we explore the value of the rate of short-term changes in MELD-Na as an independent predictor of mortality in patients with nonmetastatic HCC. Methods. We reviewed a cohort of patients diagnosed with nonmetastatic HCC at our institution between 2001 and 2011. We evaluated potential predictors of overall survival, including baseline MELD-Na and the change in MELD-Na over 90 days. We explored survival times of cohorts grouped by baseline MELD-Na and the change in MELD-Na. Results. 182 patients met eligibility criteria. With a median follow-up of 21 months for surviving patients, 110 deaths were observed (60%). Median MELD-Na at the time of diagnosis was 9.7 (IQR 7.5 to 13.9). The median changes in percentage of MELD-Na over 90 days were an increase of 9% (IQR -4% to 55%). Multivariable Cox proportional hazards modeling demonstrated that both baseline MELD-Na (HR=1.07 per unit increase, 95% CI 1.03 to 1.11, p<0.001) and changes in MELD-Na exceeding 40% (HR=3.69, 95% CI 2.39 to 5.69, p<0.001) were independently associated with increased mortality risk. Median survival among patients whose changes in MELD-Na were greater than 40% was 4.5 months, and median survival among the 131 other patients was 25.8 months (p<0.001). Conclusions. We identified a subset of HCC patients who have extremely poor prognosis by incorporating the rate of short-term change in MELD-Na to baseline MELD-Na score. |
| format | Article |
| id | doaj-art-6a0bbc6cdde4478aab2d34798f68fe46 |
| institution | Kabale University |
| issn | 2291-2789 2291-2797 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Canadian Journal of Gastroenterology and Hepatology |
| spelling | doaj-art-6a0bbc6cdde4478aab2d34798f68fe462025-02-03T05:52:01ZengWileyCanadian Journal of Gastroenterology and Hepatology2291-27892291-27972018-01-01201810.1155/2018/56819795681979Model for End-Stage Liver Disease and Sodium Velocity Predicts Overall Survival in Nonmetastatic Hepatocellular Carcinoma PatientsJustin Y. Tang0Nitin Ohri1Rafi Kabarriti2Santiago Aparo3Jennifer Chuy4Sanjay Goel5Jonathan M. Schwartz6Milan Kinkhabwala7Andreas Kaubisch8Chandan Guha9Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USADepartment of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USADepartment of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USADepartment of Medicine, Division of Medical Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USADepartment of Medicine, Division of Medical Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USADepartment of Medicine, Division of Medical Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USADepartment of Gastroenterology and Liver Diseases, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USADepartment of Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USADepartment of Medicine, Division of Medical Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USADepartment of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USABackground & Aims. The significance of short-term changes in model for end-stage liver disease and Sodium (MELD-Na) following hepatocellular carcinoma (HCC) diagnosis is unknown. In this report, we explore the value of the rate of short-term changes in MELD-Na as an independent predictor of mortality in patients with nonmetastatic HCC. Methods. We reviewed a cohort of patients diagnosed with nonmetastatic HCC at our institution between 2001 and 2011. We evaluated potential predictors of overall survival, including baseline MELD-Na and the change in MELD-Na over 90 days. We explored survival times of cohorts grouped by baseline MELD-Na and the change in MELD-Na. Results. 182 patients met eligibility criteria. With a median follow-up of 21 months for surviving patients, 110 deaths were observed (60%). Median MELD-Na at the time of diagnosis was 9.7 (IQR 7.5 to 13.9). The median changes in percentage of MELD-Na over 90 days were an increase of 9% (IQR -4% to 55%). Multivariable Cox proportional hazards modeling demonstrated that both baseline MELD-Na (HR=1.07 per unit increase, 95% CI 1.03 to 1.11, p<0.001) and changes in MELD-Na exceeding 40% (HR=3.69, 95% CI 2.39 to 5.69, p<0.001) were independently associated with increased mortality risk. Median survival among patients whose changes in MELD-Na were greater than 40% was 4.5 months, and median survival among the 131 other patients was 25.8 months (p<0.001). Conclusions. We identified a subset of HCC patients who have extremely poor prognosis by incorporating the rate of short-term change in MELD-Na to baseline MELD-Na score.http://dx.doi.org/10.1155/2018/5681979 |
| spellingShingle | Justin Y. Tang Nitin Ohri Rafi Kabarriti Santiago Aparo Jennifer Chuy Sanjay Goel Jonathan M. Schwartz Milan Kinkhabwala Andreas Kaubisch Chandan Guha Model for End-Stage Liver Disease and Sodium Velocity Predicts Overall Survival in Nonmetastatic Hepatocellular Carcinoma Patients Canadian Journal of Gastroenterology and Hepatology |
| title | Model for End-Stage Liver Disease and Sodium Velocity Predicts Overall Survival in Nonmetastatic Hepatocellular Carcinoma Patients |
| title_full | Model for End-Stage Liver Disease and Sodium Velocity Predicts Overall Survival in Nonmetastatic Hepatocellular Carcinoma Patients |
| title_fullStr | Model for End-Stage Liver Disease and Sodium Velocity Predicts Overall Survival in Nonmetastatic Hepatocellular Carcinoma Patients |
| title_full_unstemmed | Model for End-Stage Liver Disease and Sodium Velocity Predicts Overall Survival in Nonmetastatic Hepatocellular Carcinoma Patients |
| title_short | Model for End-Stage Liver Disease and Sodium Velocity Predicts Overall Survival in Nonmetastatic Hepatocellular Carcinoma Patients |
| title_sort | model for end stage liver disease and sodium velocity predicts overall survival in nonmetastatic hepatocellular carcinoma patients |
| url | http://dx.doi.org/10.1155/2018/5681979 |
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