Validation of the HCC-MELD for dropout probability in patients with small hepatocellular carcinoma undergoing locoregional therapy Huo T-I, Huang Y-H, Su C-W, Lin H-C, Chiang J-H, Chiou Y-Y, Huo SC, Lee P-C, Lee S-D. Validation of the HCC-MELD for dropout probability in patients with small hepatocellular carcinoma undergoing locoregional therapy. Clin Transplant 2008: 22: 469–475. ª 2008 Wiley Periodicals, Inc. Abstract: Background: The model for end-stage liver disease (MELD) is used in prioritizing cirrhotic patients awaiting liver transplantation. Patients with small hepatocellular carcinoma (HCC) are eligible candidates. An HCC-MELD equation was recently proposed to predict the dropout rate of HCC patients on the waiting list. This study aimed to validate the accuracy of this equation. Methods: We investigated 390 patients with small HCC who were candidates for liver transplantation and underwent locoregional therapy. Results: The estimated probability of dropout according to the equation was 8.2% for T1 stage and 13.5% for T2 stage HCC (p < 0.0001). The actual disease progression rate at three months was 2.1% for T1 and 3.0% for T2 stage HCC. At six months, the progression rate was 5.3% for T1 stage and 6.8% for T2 stage. The area under receiver operating character- istic curve of the HCC-MELD equation was 0.81 at three months and 0.80 at six months. Patients undergoing radiofrequency ablation (RFA) had significantly lower dropout rates compared with other treatment groups according to the equation (p = 0.0007). The actual tumor progression rate was also the lowest for the RFA group at both three and six months. Conclusion: The HCC-MELD equation is a feasible predictive model for patients with small HCC undergoing locoregional therapy. Teh-Ia Huo a,c , Yi-Hsiang Huang a,d , Chien-Wei Su a,e , Han-Chieh Lin a,e , Jen-Huei Chiang b,e , Yi-You Chiou b,e , Samantha C. Huo f , Pui-Ching Lee a and Shou-Dong Lee a,e Departments of a Medicine and b Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, c Institute of Pharmacology, d Institute of Clinical Medicine, e Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan and f Washington University, St. Louis, MO, USA The first three authors (T.-I. Huo, Y.-H. Huang and C.-W. Su) have contributed equally to this work. Key words: hepatocellular carcinoma – liver cirrhosis – liver transplantation – model for end-stage liver disease Abbreviations: AFP, a-fetoprotein; AUC, area under the ROC curve; HBV, hepatitis B virus; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; MELD, model for end-stage liver disease; PAI, percutaneous acetic acid injection; PEI, percutaneous ethanol injection; RFA, radiofrequency ablation; ROC, receiver operating characteristic; TACE, transarterial chemoembolization Corresponding author: Teh-Ia Huo, MD, Division of Gastroenterology, Taipei Veterans General Hospital, Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan. Tel.: + 886 2 2871 2121 (ext. 3055); fax: + 886 2 2873 9318; e-mail: tihuo@vghtpe.gov.tw Accepted for publication 17 January 2008 Clin Transplant 2008: 22: 469–475 DOI: 10.1111/j.1399-0012.2008.00811.x ª 2008 Wiley Periodicals, Inc. 469