Atif Zaman, MD, MPH

Five-year HCC survival rates increased from 13% to 22% after a 2003 policy accounted for tumor burden in assigning transplantation priority.

In 2003, patients with hepatocellular carcinoma (HCC) began receiving Model for End-stage Liver Disease (MELD) exception points if they met Milan criteria for limited tumor burden. After the implementation of this policy, the rates of liver transplantation in patients with HCC markedly increased. But did patient survival improve?

To find out, investigators used data from the large, U.S.–population-based Surveillance and Epidemiology End Results (SEER) cancer registry to compare 5-year survival rates between the pre–MELD exception era (1998–2003) and the post–MELD exception era (2004–2010) in patients with HCC.

The study cohort comprised 60,772 patients with HCC. Compared with patients in the pre–MELD exception era (15,541 patients), patients in the post–MELD exception era (45,209) had significantly higher 5-year survival (21.9% vs. 13.0%, P<0.001). This difference remained significant after adjustment for covariates such as gender, ethnicity, and type of HCC treatment (hazard ratio, 0.87). Most of the survival benefit was observed among patients who did not undergo liver transplantation. Among racial and Hispanic ethnicity groups, Asian patients had better HCC survival overall, whereas black patients had the least favorable outcomes.

Citation(s):

Wong RJ et al. Increased long-term survival among patients with hepatocellular carcinoma after implementation of Model for End-stage Liver Disease score. Clin Gastroenterol Hepatol 2014 Sep; 12:1534.