Comparative Prognostic Performance of Liver Function Scores in Unresectable Hepatocellular Carcinoma Treated with First-Line Sorafenib

Öz

This study compared the prognostic performance of four liver function scores (the Child–Pugh score, Model for End-Stage Liver Disease [MELD], Model for End-Stage Liver Disease-Sodium [MELD-Na], and MELD 3.0) in patients with unresectable hepatocellular carcinoma receiving first-line sorafenib. A total of 120 patients treated between June 2019 and April 2025 were included in this retrospective, single-center cohort. Overall survival (OS) was the primary outcome. The discriminatory performance of the four scores was assessed at 3, 6, and 12 months using time-dependent receiver operating characteristic analysis, and their associations with OS were evaluated using Cox regression. During follow-up, 107 patients (89.2%) died, and median OS was 5.62 months. MELD 3.0 showed the highest discrimination at 3, 6, and 12 months, with area under the curve values of 0.769, 0.790, and 0.710, respectively. At 6 months, MELD 3.0 showed significantly better discrimination than MELD and MELD-Na after adjustment for multiple comparisons, whereas no significant difference was observed between MELD 3.0 and the Child–Pugh score. In multivariable analysis, MELD 3.0 and Eastern Cooperative Oncology Group performance status remained independently associated with OS. In an exploratory analysis, median OS was 10.78 months in patients with MELD 3.0 <10 and 4.07 months in those with MELD 3.0 ≥10. MELD 3.0 may provide an objective measure of hepatic reserve for risk stratification in patients with unresectable hepatocellular carcinoma, although its performance was not superior to the Child–Pugh score.

Anahtar Kelimeler

• Carcinoma Hepatocellular
• Sorafenib
• Prognosis
• Liver Function Tests
• ROC Curve

Etik Beyan

Approving Committee: Ankara Bilkent City Hospital Medical Research Scientific and Ethical Evaluation Board Approval Date: August 27, 2025 Decision No: 1-25-1634

Birinci Basamak Sorafenib ile Tedavi Edilen Rezeke Edilemeyen Hepatoselüler Karsinomda Karaciğer Fonksiyon Skorlarının Karşılaştırmalı Prognostik Performansı

Öz

Bu çalışmada, birinci basamak sorafenib tedavisi alan rezeke edilemeyen hepatoselüler karsinom hastalarında dört karaciğer fonksiyon skorunun (Child–Pugh skoru, Son Dönem Karaciğer Hastalığı Modeli [MELD], Son Dönem Karaciğer Hastalığı Modeli-Sodyum [MELD-Na] ve MELD 3.0) prognostik performansı karşılaştırıldı. Haziran 2019 ile Nisan 2025 arasında tedavi edilen toplam 120 hasta bu retrospektif, tek merkezli kohorta dahil edildi. Primer sonlanım noktası genel sağkalım (GS) idi. Dört skorun ayırt edici performansı 3, 6 ve 12. aylarda zamana bağlı alıcı işletim karakteristiği analizi ile değerlendirildi ve GS ile ilişkileri Cox regresyon analizi kullanılarak incelendi. Takip süresince 107 hasta (%89,2) öldü ve medyan GS 5,62 ay olarak bulundu. MELD 3.0, 3, 6 ve 12. aylarda sırasıyla 0,769, 0,790 ve 0,710 eğri altında kalan alan değerleriyle en yüksek ayırt edici performansı gösterdi. Altıncı ayda MELD 3.0, çoklu karşılaştırmalar için düzeltme sonrasında MELD ve MELD-Na'dan anlamlı olarak daha iyi ayırt edici performans gösterirken, MELD 3.0 ile Child–Pugh skoru arasında anlamlı fark saptanmadı. Çok değişkenli analizde MELD 3.0 ve Doğu Kooperatif Onkoloji Grubu performans durumu GS ile bağımsız olarak ilişkili bulundu. Keşifsel analizde medyan GS, MELD 3.0 <10 olan hastalarda 10,78 ay, MELD 3.0 ≥10 olanlarda ise 4,07 aydı. MELD 3.0, rezeke edilemeyen hepatoselüler karsinom hastalarında risk sınıflandırması için karaciğer rezervinin objektif bir göstergesi olabilir; ancak performansı Child–Pugh skorundan üstün değildi.

Anahtar Kelimeler

• Hepatoselüler Karsinom
• Sorafenib
• Prognoz
• Karaciğer Fonksiyon Testleri
• ROC Eğrisi

Etik Beyan

Onaylayan Kurul: Ankara Bilkent Şehir Hastanesi Tıbbi Araştırmalar Bilimsel ve Etik Değerlendirme Kurulu Onay Tarihi: 27 Ağustos 2025 Karar No: 1-25-1634

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