Prognosis and survival for liver cancer
If you have liver cancer, you may have questions about your prognosis. A prognosis is the doctor’s best estimate of how cancer will affect someone and how it will respond to treatment. Prognosis and survival depend on many factors. Only a doctor familiar with your medical history, the type and stage and other features of the cancer, treatments chosen and the response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together. They both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic and predictive factors for liver cancer.
Stage
The stage is one of the most important factors for liver cancer. People with liver cancer that is BCLC stage 0 or A have a more favourable prognosis than people with liver cancer that is BCLC stage B, C or D.
Liver function
People with poor liver function caused by the tumour, scarring of the liver (called cirrhosis) or hepatitis have a poor prognosis.
The Child-Pugh score
The Child-Pugh score is an estimate of how well the liver is working. It is used to decide if it is safe to do surgery. It is a scoring system that measures the level of liver damage or failure caused by cirrhosis. It looks at the following factors (each factor is given between 1 and 3 points):
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if there is a buildup of fluid in the abdomen (called ascites)
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if there are symptoms of hepatic encephalopathy (a condition that develops when the liver doesn’t work properly and waste products build up in the blood)
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bilirubin level
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albumin level
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how long it takes the blood to clot (called prothrombin time, or PT)
| Factor | Number of points given | ||
|---|---|---|---|
| & #160; | 1 | 2 | 3 |
| ascites | absent | mild | moderate or severe |
| hepatic encephalopathy | none |
grade 1 – mild
some changes to mental and physical function grade 2 – moderate many changes to mental and physical function |
grade 3 – poor
significant changes to mental and physical function grade 4 – severe significant changes to mental and physical function or coma |
| bilirubin (mg/dL) | less than 2 | 2 to 3 | greater than 3 |
| albumin (g/dL) | greater than 3.5 | 2.8 to 3.5 | less than 2.8 |
| prothrombin time (seconds) | 1 to 3 | 4 to 6 | greater than 6 |
The total number of points across the categories are added together to get the Child-Pugh score:
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A = 5 to 6 points
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B = 7 to 9 points
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C = 10 to 15 points
A high Child-Pugh score means that surgery is not safe to do and should not be performed. People who can’t have surgery have a poorer prognosis than people who can have surgery to remove liver cancer.
Performance status
Performance status measures how well you can do daily activities and is based on the Eastern Cooperative Oncology Group (ECOG) score. People with a good or fair performance status have a better prognosis than people with a poor performance status.
Tumour characteristics
People with only one tumour in the liver have a better prognosis than people with many tumours. When the tumours are all in one lobe, the prognosis is better than when the tumours are in both lobes of the liver.
A tumour growing inside or that has grown into blood vessels has a poor prognosis.
A tumour smaller than 5 cm has a better prognosis than larger tumours.
Type of tumour
Fibrolamellar carcinoma has a better prognosis than other types of liver cancer. These tumours do not grow very deeply into the surrounding tissues, so doctors can usually completely remove them with surgery.