A new direction in quantifying cirrhosis to predict overall survival after liver surgical resection for hepatocellular carcinoma

The Ishak score is based on extent of fibrosis, degree of architectural disturbances within the portal tract and hepatic venules, and definitive cirrhosis.2 In addition to cirrhosis, the model by Li et al. also incorporates a preoperative radiographic tumor burden score (TBS) and alpha-fetoprotein (AFP) level to predict overall survival after liver surgical resection. The proposed model by Li et al. includes histologically-defined cirrhosis, which would require a preoperative biopsy of non-cancerous liver parenchyma. Since a Li-RADS 5 lesion is pathognomonic with HCC, and therefore not requiring a biopsy for confirmation, the purposed prognostic model by Li et al. would require an additional step of performing a liver biopsy to obtain histologic confirmation of cirrhosis. The advantages of using a Fibroscan over a liver biopsy include a lower risk profile and potentially decreased cost in the long-term if indeed it demonstrates superior prognostic value. [...]the incorporation of a discrete and easy measure for cirrhosis provides the potential for widespread use.