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Clin Gastroenterol Hepatol. 2006 Dec;4(12):1528-36.

Staging hepatocellular carcinoma by a novel scoring system (BALAD score) based on serum markers.

Author information

1
Department of Gastroenterology, Ogaki Municipal Hospital, Ogaki, and Department of Gastroenterology and Hepatology, Kinki University School of Medicine, Osaka-Sayama, Japan.

Abstract

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.

PMID:
17162244
DOI:
10.1016/j.cgh.2006.09.021
[Indexed for MEDLINE]

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