Simple Clinical Prognostic Model for Hepatocellular Carcinoma in Developing Countries and Its Validation

Purpose: More than 80% of hepatocellular carcinomas (HCCs) worldwide occur in developing countries, especially in Asia. It often presents at an advanced stage beyond treatment. In this circumstance, a simple prognostic model is useful. Previous prognostic models require radiologic and laboratory investigations that are not readily available in developing countries. Our aim is to formulate and then validate a simple clinical prognostic model for HCC in an Asian population using only clinical parameters and with serum alpha-fetoprotein (AFP) as the sole laboratory test. Patients and Methods: Cox regression modeling was performed on several clinical parameters and serum AFP level in 397 patients with HCC who received only supportive care in Singapore. A later group of 324 HCC patients from an Asia-Pacific–wide randomized trial was then used to validate the model. Results: Ascites, physical performance status, and serum AFP were independently predictive of survival. Cox analysis yielded a simple score based o...