We planned a priori to incorporate the Model for Endstage Liver Disease (MELD) as a gauge of liver disease severity. MELD has been shown to be a useful measure of hepatic insufficiency because it was adopted

as a standard to determine organ allocation priorities among liver transplant candidates in the U.S. and elsewhere.12, 13 One of the appeals of MELD is that it consists only of laboratory variables that are widely available and reproducible, consistent with the goal of the work. Selleck CT99021 HCC, hepatocellular carcinoma; MELD, model for endstage liver disease; MESIAH, model to estimate survival in ambulatory HCC patients. This analysis incorporates two sets of data such that a survival model was derived from the first dataset and then applied to the second set to examine its validity. The first dataset, used to derive the survival model, consisted of HCC patients at Mayo Clinic Rochester (“derivation cohort” henceforth). This was

derived from a prospective database tracking HCC cases at Mayo Clinic Rochester. When the database was started in the early 1990s, the scope of the database was limited to HCCs from a viral etiology (chronic hepatitis B virus [HBV] or hepatitis C virus [HCV] infection). Although cases from other etiologies have sporadically been added since, the database captured all patients with chronic viral hepatitis. These patients Rucaparib datasheet enrolled in the database between January 1994 and December 2008 were included in the analysis. HBV infection was ascertained by positive serum HBsAg, whereas HCV infection was defined by (1) detectable HCV RNA or)2) positive anti-HCV with a documented history of chronic liver disease. Patient demographic information,

HCC etiology, performance status, laboratory data at the initial assessment of HCC were extracted from medical records. Principally, the AASLD guideline was used to define HCC.14 Thus, of the 477 patients represented in the data, a majority (n = 323) was diagnosed by histology, whereas the radiographic criteria were met in 108 upon review this website by a single radiologist (B.H.K.). In addition, we included 46 patients who had lesions with compatible cross-sectional and angiographic imaging characteristics and underwent transarterial chemoembolization (TACE) or transarterial radioembolization (TARE).15 The second dataset (“validation cohort” henceforth) was obtained in 904 patients diagnosed with HCC between November 2000 and December 2003 at the Center for Liver Cancer at National Cancer Center in Goyang, South Korea.16 The diagnosis of HCC was made following a previously published local guideline, based on histology and/or clinical evidence such as radiographic characteristics, serum alpha fetoprotein (AFP) levels, and the presence of risk factors.17 HCC was diagnosed in the absence of histological evidence, if risk factors for HCC (i.e.