Obvious examples include liver transplantation as well as TACE and molecular targeted therapy, which have been shown to improve patient survival. In order to analyze the magnitude of this concern, we showed in a sensitivity analysis that censoring patients at liver transplantation did not affect the

results. Further examination of this issue in patient groups in whom no intervention is applied is certainly desirable, although a pure natural history cohort with all the necessary data is not very likely to be found easily. Importantly, whether MESIAH may inform treatment decisions remains to be determined. For example, this website a patient with poor liver function and early stage HCC may have a risk score (and expected survival) similar to that of a patient with preserved liver function and advanced HCC. The optimal therapy, however, would be different for the two patients. As with other decision aids based on mathematical models, our risk score is best thought of as a guide that must be tempered by clinician’s acumen and experience. We acknowledge other limitations of the study. First, we had only a small portion

of patients (2% in the derivation and 1% in the validation cohorts) with a high MELD score (e.g., >30). This mitigates our confidence with which we can rely on PI3K inhibitor the predicted survival and, thus, further validation of the model in patients with a high MELD score is warranted. The vast majority of our patients had preserved performance status, which is known to be an important prognostic indicators. To what extent our model applies to patients with poor performance remains to be determined. Because HCC patients with poor performance status (i.e., ECOG status 3-4: bed-ridden >50% of the time) have

extremely limited survival, the utility of a prediction tailored for those patients is likely limited. Given these limitations, we look forward to further validation of the MESIAH score in other patient cohorts to highlight its complementary role to the BCLC and other staging systems. MCE In summary, based on large cohorts of patients with HCC, we have developed and validated a survival model for HCC based on readily reproducible predictors. Although further studies will strengthen its validity, evidence herein shows that the model outperforms other staging systems such as the BCLC, CLIP, or JIS score. Based on these data, we propose that the MESIAH score is useful in epidemiologic research and in clinical practice for patient counseling and prognostication. Additional Supporting Information may be found in the online version of this article. “
“Nonalcoholic fatty liver disease (NAFLD) is present in up to 30% of Americans and 25% of Asians and therefore is present in millions of individuals, making it the commonest liver condition in the world.