Comparative Prognostic Performance of Liver Function Scores in Unresectable Hepatocellular Carcinoma Treated with First-Line Sorafenib

This study compared the prognostic performance of four liver function scores (the Child–Pugh score, Model for End-Stage Liver Disease [MELD], Model for End-Stage Liver Disease-Sodium [MELD-Na], and MELD 3.0) in patients with unresectable hepatocellular carcinoma receiving first-line sorafenib. A total of 120 patients treated between June 2019 and April 2025 were included in this retrospective, single-center cohort. Overall survival (OS) was the primary outcome. The discriminatory performance of the four scores was assessed at 3, 6, and 12 months using time-dependent receiver operating characteristic analysis, and their associations with OS were evaluated using Cox regression. During follow-up, 107 patients (89.2%) died, and median OS was 5.62 months. MELD 3.0 showed the highest discrimination at 3, 6, and 12 months, with area under the curve values of 0.769, 0.790, and 0.710, respectively. At 6 months, MELD 3.0 showed significantly better discrimination than MELD and MELD-Na after adjustment for multiple comparisons, whereas no significant difference was observed between MELD 3.0 and the Child–Pugh score. In multivariable analysis, MELD 3.0 and Eastern Cooperative Oncology Group performance status remained independently associated with OS. In an exploratory analysis, median OS was 10.78 months in patients with MELD 3.0 <10 and 4.07 months in those with MELD 3.0 ≥10. MELD 3.0 may provide an objective measure of hepatic reserve for risk stratification in patients with unresectable hepatocellular carcinoma, although its performance was not superior to the Child–Pugh score.