Advanced Liver Cancer Prognostic System (ALPCS )
The Advanced Liver Cancer Prognostic System (ALPCS), formulated by Yau et al. in 2008, aims to optimally stage advanced HCC patients unsuitable for surgery or locoregional therapy. Derived from a Hong Kong cohort of 1470 patients, it incorporates 11 prognostic factors (ascites, abdominal pain, weight loss, Child-Pugh grade, ALP, serum total bilirubin, serum AFP, serum urea, tumor size, portal thrombosis, lung metastasis) using a multivariate Cox model. Points are assigned to each factor based on regression coefficients, leading to three prognostic groups (score ≤ 8: favorable, 9-15: intermediate, ≥ 16: poor) based on total scores (range: 0-39). Survival curves demonstrate distinct differences, with median OS of 7.9, 3.2, and 1.4 months for good, intermediate, and poor groups, respectively. Discriminatory ability (AUC 0.77) surpasses Okuda (AUC 0.66) and CLIP (AUC 0.71). Although derived primarily from HBV-infected patients, validation in Western populations with HCV or alcohol history is necessary.
| Variable | 0 | 1 | 2 | 3 | 4 | 5 |
|---|---|---|---|---|---|---|
| Patient characteristics | ||||||
| Ascites | No | Yes | ||||
| Abdominal pain | No | Yes | ||||
| Weight loss | No | Yes | ||||
| Child-Pugh | A | B | C | |||
| Biochemistry | ||||||
| ALP (IU/L) | ≤ 200 | > 200 | ||||
| Total bilirubin (mmol/L) | ≤ 33 | 33-50 | > 50 | |||
| Urea (mmol/L) | ≤ 8.9 | > 8.9 | ||||
| Tumor characteristics |
||||||
| Portal vein thrombosis | No | Yes | ||||
| Tumor size | ≤ 5 cm | > 5 cm | Diffuse | |||
| Lung metastasis | No | Yes | ||||
| Alpha-fetoprotein (ng/mL) | ≤ 400 | > 400 | ||||
| Prgnosis | Score | 3 month survival | ||
|---|---|---|---|---|
| Good | 0-2 | >0.81 | ||
| 3-6 | 0.72-0.80 | |||
| 7-8 | 0.66-0.69 | |||
| Intermediate | 9 | 0.63 | ||
| 10-12 | 0.51-0.59 | |||
| 13-14 | 0.42-0.47 | |||
| 15 | 0.38 | |||
| Poor | 16 | 0.33 | ||
| 17-19 | 0..21-0.29 | |||
| 20-22 | 0.10-0.17 | |||
| ≥23 | <0.10 |
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