Comparison of Child-Pugh and MELD scores in predicting survival of hepatocellular carcinoma patients with splenomegaly undergoing TACE: a real-world study.
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OBJECTIVE: This study aims to compare the predictive value of Child-Pugh and MELD scores for the survival rate of HCC patients with splenomegaly who received TACE. METHODS: From January 2018 to January 2025, 306 patients with splenomegaly and HCC who underwent TACE treatment at a tertiary hospital were included in the study. Patients were divided into groups A (n = 183), B (n = 92), and C (n = 31) based on the baseline Child-Pugh score. At the same time, patients were divided into low-risk (MELD<10, n = 122), intermediate-risk (MELD10-20, n = 122), and high-risk (MELD>20, n = 62) groups based on the baseline MELD score. Baseline clinical pathological characteristics were collected. The primary endpoint was overall survival (OS) and progression-free survival (PFS). Survival analysis was performed using the Kaplan-Meier method, and the time series test was used to evaluate the comparison between groups. The receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of the two scoring systems for 1-year postoperative survival rate, and the DeLong test was used for comparison. RESULTS: The comparison analysis of baseline characteristics showed that there were statistically significant differences in age, maximum tumor diameter, proportion of multifocal tumors, spleen length, total bilirubin, albumin, international normalized ratio (INR), creatinine, red blood cell distribution width (RDW), platelet count, and the incidence of ascites and hepatic encephalopathy among different Child-Pugh grades (all p < 0.05). Similarly, significant differences were observed in the above parameters among different MELD risk groups (all p < 0.05). Survival analysis indicated that with the increase in Child-Pugh grade, OS and PFS were significantly decreased (log-rank χ2 = 45.332, p < 0.001; χ2 = 38.775, p < 0.001). Similarly, with the increase in MELD risk category, OS and PFS significantly decreased (log-rank χ2 = 52.114, p < 0.001; χ2 = 41.889, p < 0.001). The predictive performance analysis indicated that compared with the Child-Pugh score, the MELD score had a significantly larger area under the curve (AUC) for predicting 1-year survival rate (DeLong test Z = 3.124, p = 0.002). CONCLUSION: In patients with HCC and splenomegaly, both Child-Pugh and MELD scores can effectively stratify prognosis. However, the MELD score showed superior predictive performance for 1-year survival rate after TACE, which is worthy of more attention in clinical prognosis assessment.